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Sports Medicine ISSN 0112-1642 Sports MedDOI 10.1007/s40279-013-0063-8
Water Immersion Recovery for Athletes:Effect on Exercise Performance andPractical Recommendations
Nathan G. Versey, Shona L. Halson &Brian T. Dawson
1 23
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REVIEW ARTICLE
Water Immersion Recovery for Athletes: Effect on ExercisePerformance and Practical Recommendations
Nathan G. Versey • Shona L. Halson •
Brian T. Dawson
� Springer International Publishing Switzerland 2013
Abstract Water immersion is increasingly being used by
elite athletes seeking to minimize fatigue and accelerate
post-exercise recovery. Accelerated short-term (hours to
days) recovery may improve competition performance,
allow greater training loads or enhance the effect of a given
training load. However, the optimal water immersion pro-
tocols to assist short-term recovery of performance still
remain unclear. This article will review the water immer-
sion recovery protocols investigated in the literature, their
effects on performance recovery, briefly outline the
potential mechanisms involved and provide practical rec-
ommendations for their use by athletes. For the purposes of
this review, water immersion has been divided into four
techniques according to water temperature: cold water
immersion (CWI; B20 �C), hot water immersion (HWI;
C36 �C), contrast water therapy (CWT; alternating CWI
and HWI) and thermoneutral water immersion (TWI; [20
to\36 �C). Numerous articles have reported that CWI can
enhance recovery of performance in a variety of sports,
with immersion in 10–15 �C water for 5–15 min duration
appearing to be most effective at accelerating performance
recovery. However, the optimal CWI duration may depend
on the water temperature, and the time between CWI and
the subsequent exercise bout appears to influence the effect
on performance. The few studies examining the effect of
post-exercise HWI on subsequent performance have
reported conflicting findings; therefore the effect of HWI
on performance recovery is unclear. CWT is most likely to
enhance performance recovery when equal time is spent in
hot and cold water, individual immersion durations are
short (*1 min) and the total immersion duration is up to
approximately 15 min. A dose-response relationship
between CWT duration and recovery of exercise perfor-
mance is unlikely to exist. Some articles that have reported
CWT to not enhance performance recovery have had
methodological issues, such as failing to detect a decrease
in performance in control trials, not performing full-body
immersion, or using hot showers instead of pools. TWI has
been investigated as both a control to determine the effect
of water temperature on performance recovery, and as an
intervention itself. However, due to conflicting findings it
is uncertain whether TWI improves recovery of subsequent
exercise performance. Both CWI and CWT appear likely to
assist recovery of exercise performance more than HWI
and TWI; however, it is unclear which technique is most
effective. While the literature on the use of water immer-
sion for recovery of exercise performance is increasing,
further research is required to obtain a more complete
understanding of the effects on performance.
1 Introduction
Athletic training typically involves a progressive increase
in training load to levels beyond which the body has
become accustomed then, by adapting to the new stress,
improvements in performance may occur provided ade-
quate recovery is allowed [1]. However, due to the high
frequency, intensity and volume of training and competi-
tion, elite athletes often experience high degrees of fatigue
[1]. For the purposes of this review, fatigue is defined as
the sensation of tiredness and associated decrements in
N. G. Versey (&) � S. L. Halson
Performance Recovery, Australian Institute of Sport,
PO Box 176, Belconnen, Canberra, ACT 2616, Australia
e-mail: [email protected]
N. G. Versey � B. T. Dawson
School of Sport Science, Exercise and Health,
The University of Western Australia, Perth, WA, Australia
Sports Med
DOI 10.1007/s40279-013-0063-8
Author's personal copy
muscular performance and function [2]. Fatigue may result
from an individual session and impair athletic performance
for minutes to days. Alternatively, fatigue can accumulate
throughout a training block or tournament, this is often
referred to as overreaching and may last days to weeks [1,
3–5]. Fatigue has been acknowledged as a complex phe-
nomenon [2], and while the causes are not fully under-
stood, a combination of both central and peripheral factors
are likely [6].
To maximize training and competition performance,
fatigue should be minimized by recovering as fast as pos-
sible. Recovery refers to the restoration of the body’s
physiological and psychological processes, allowing ath-
letes to potentially return to their pre-fatigue state and
performance level [7]. However, in many circumstances,
only partial recovery is possible due to the short duration
between successive exercise bouts and the high degrees of
fatigue experienced by many athletes [3–5]. This article
will focus on what has previously been referred to as
‘training recovery’, which is recovery between successive
training sessions or competitions [8].
Elite athletes are increasingly using specific techniques
to accelerate recovery and gain a competitive advantage.
Accelerated recovery may allow athletes to be less fatigued
in competition, sustain greater training loads or enhance
the effect of a given training load [9]. Water immersion is
one recovery technique that is both widely used by athletes
[10] and has been examined in the scientific literature
(Table 1). Following exercise, participants typically
immerse all or part of their body in water; however, the
optimal protocols to assist recovery of exercise perfor-
mance remain unclear. The water temperature, immersion
duration, timing, immersion depth and activity level can all
vary.
For the purposes of this review, water immersion for
recovery of athletic performance has been divided into four
techniques according to water temperature: cold water
immersion (CWI; B20 �C), hot water immersion (HWI;
C36 �C), contrast water therapy (CWT; alternating CWI
and HWI) and thermoneutral water immersion (TWI; [20
to \36 �C). All studies claiming to investigate CWI have
used temperatures B20 �C; therefore, this cut-off has been
used for CWI. Water temperatures of approximately 35 �C
are considered to be thermoneutral as they do not alter core
temperature during prolonged immersion [11]; however,
water temperatures as low as 21 �C have been included in
TWI to incorporate the use of swimming pools that are
likely to cause limited body cooling [11]. In comparison,
immersion in C36 �C water was defined as HWI as it will
increase core temperature [11]. This paper aims to review
the water immersion recovery protocols for each technique,
their effect on recovery of performance and provide prac-
tical recommendations for use by athletes. A greater
understanding of the performance effects will allow sports
scientists and coaches to optimize the water immersion
protocols they recommend to athletes, thereby aiding post-
exercise recovery.
While many of the physiological responses to water
immersion are relatively well documented [12–14], the
exact mechanisms by which recovery of performance
might be affected remain uncertain and may differ between
modes of exercise depending on the mechanisms of fatigue
involved. A brief description of the potential mechanisms
has been included to assist with understanding why studies
may differ in their effects on performance recovery. The
potential mechanisms are likely to be associated primarily
with the effects of hydrostatic pressure and water temper-
ature on the body [15]. Hydrostatic pressure is likely to
cause an elevation in cardiac output, muscle blood flow and
diffusion of metabolic waste products from muscle to the
blood [15–17], possibly assisting recovery by enhancing
removal of metabolic waste products produced during
exercise [15–17] and reducing the transport time of oxy-
gen, nutrients and hormones to fatigued muscles [12, 15,
16]. Furthermore, hydrostatic pressure may limit formation
of oedema following exercise, possibly reducing further
muscle damage, maintaining oxygen delivery to muscles
and maintaining contractile function [15].
Water temperature may influence these physiological
responses and potential mechanisms through changes in
skin temperature. During HWI superficial vasodilation and
an increase in blood flow is likely to occur; conversely
CWI is associated with vasoconstriction and a relative
decrease in blood flow [15, 18, 19]. It is recognized that
cryotherapy reduces inflammatory responses and alleviates
muscle spasm and pain following acute soft tissue injuries
[20–22], similar responses may occur following CWI due
to a reduction in nerve conduction velocity [23, 24]. Fur-
thermore, both CWI and CWT may promote recovery by
accelerating post-exercise decreases in heat storage and
core temperature to homeostasis or below [25–32], while
HWI may slow decreases in core temperature [28]. Similar
changes in intramuscular temperature have been shown in
response to CWI [29, 33, 34] and HWI [35, 36]. If muscle
temperature is elevated during subsequent exercise it may
enhance muscle function and performance [37]. Con-
versely, performance during longer duration tests, partic-
ularly in warm to hot environmental conditions is likely to
be improved by a reduction in core temperature due to a
pre-cooling effect [38, 39]. More detailed explanations of
these potential mechanisms are available in recent review
articles [15, 40–42].
In total, 214 studies were retrieved for the present
review through PubMed searches before 31 March 2012
using the keywords ‘water immersion’, ‘hydrotherapy’,
‘ice bath’, ‘cryotherapy’, ‘spa’, ‘hot tub’, ‘jacuzzi’, ‘pool’,
N. G. Versey et al.
Author's personal copy
Ta
ble
1S
tud
ies
exam
inin
gth
eef
fect
of
wat
erim
mer
sio
nte
chn
iqu
eso
nre
cov
ery
of
exer
cise
per
form
ance
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Asc
ensa
o
etal
.[6
9]
Jun
ior
nat
ion
al
leag
ue
foo
tbal
lers
(20
[M])
Ran
do
miz
ed
tria
ls
Jun
ior
frie
nd
ly
foo
tbal
lm
atch
CW
I:1
0m
inin
10
�Cst
irre
dw
ater
toil
iac
cres
tse
ated
(n=
10
)
Imm
edia
tely
po
st-m
atch
20
msp
rin
t,sq
uat
jum
p,
CM
J,q
uad
rice
ps
MV
IC,
Mg
,C
K,
CR
P,
RP
E,
per
ceiv
edco
ldn
ess,
mu
scle
sore
nes
s
\0
.5,
24
,4
8h
CW
I:;
CK
ver
sus
TW
Iat
24
and
48
h.;
Mg
ver
sus
TW
Iat
0.5
h,;
inC
RP
ver
sus
TW
Iat
0.5
and
24
h,:
MV
ICv
ersu
s
TW
Iat
24
h,;
calf
and
qu
adri
cep
sm
usc
le
sore
nes
sv
ersu
sT
WI
at
24
h
TW
I:1
0m
inin
35
�Cto
ilia
ccr
est
seat
ed(n
=1
0)
Bai
ley
etal
.
[56
]
Hab
itu
ally
acti
ve
adu
lts
(20
[M])
Ran
do
miz
ed
con
tro
ltr
ial
LIS
T(9
0m
ino
f
inte
rmit
ten
t
sim
ula
ted
foo
tbal
l
acti
vit
y)
CW
I:1
0m
inin
10
�Cag
itat
ed
wat
erto
ilia
ccr
est,
seat
ed
Imm
edia
tely
po
st-e
xer
cise
Kn
eeex
ten
sio
nan
dfl
exio
n
MV
IC,
rep
eate
dsp
rin
t
test
,sq
uat
jum
p,
HR
,
hae
mo
glo
bin
,
hae
mat
ocr
it,
chan
ge
in
pla
sma
vo
lum
e,C
K,
Mg
,
core
tem
per
atu
re,
bo
dy
mas
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usc
leso
ren
ess,
per
ceiv
edco
ldn
ess,
RP
E
0,
1,
24
,4
8,
16
8h
(no
blo
od
mar
ker
s
at1
68
h).
Rep
eat
spri
nt
test
at4
8h
CW
I::
kn
eefl
exio
nM
VIC
at2
4-
and
48
-hp
ost
-
exer
cise
,an
dp
erce
ived
cold
nes
sd
uri
ng
CW
Ian
d
reco
ver
yv
ersu
sC
ON
.;
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at1
-hp
ost
-ex
erci
se,
and
mu
scle
sore
nes
sfo
r
up
to4
8h
ver
sus
CO
N
CO
N:
10
min
seat
ed
rest
Bo
sak
etal
.
[73
]
Tra
ined
run
ner
s(1
2
[9M
,3
F])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
5k
mru
nn
ing
per
form
ance
tria
l.R
epea
ted
24
hla
ter
CW
I:1
2m
inin
16
�C.
Po
stu
rean
d
dep
thn
ot
rep
ort
ed
Imm
edia
tely
po
st-e
xer
cise
5k
mru
nn
ing
per
form
ance
,
HR
,R
PE
,p
erce
ived
fati
gu
e,m
usc
leso
ren
ess
24
hC
WI:;
5k
mru
nn
ing
tim
e,
aver
age
HR
and
po
st-t
rial
RP
Ev
ersu
sC
ON
CO
N:
Pas
siv
e
reco
ver
y
Bro
ph
y-
Wil
liam
s
etal
.[6
4]
Wel
ltr
ain
ed
team
spo
rt
ath
lete
s
(8[M
])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
Ru
nn
ing
hig
h-
inte
nsi
ty
inte
rval
sess
ion
(89
3m
inat
90
%
v-V
O2m
ax).
CW
I:1
5m
inin
15
�Cto
mid
ster
nal
lev
el,
po
stu
ren
ot
rep
ort
ed
2C
WI
tria
ls
per
form
ed
imm
edia
tely
or
3h
po
st-
exer
cise
Yo
yo
Inte
rmit
ten
t
Rec
ov
ery
test
,H
R,
La,
CR
P,
per
ceiv
edre
cov
ery
,
mu
scle
sore
nes
s
24
hC
WI:
imm
edia
tely
po
st-
exer
cise
;:
Yo
yo
per
form
ance
and
per
ceiv
edre
cov
ery
,;
CR
Pv
ersu
sC
ON
.3
h
po
st-e
xer
cise
;li
kel
y:
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yo
per
form
ance
and
per
ceiv
edre
cov
ery
ver
sus
CO
N.
Imm
edia
tely
po
st-
exer
cise
;li
kel
y:
Yo
yo
per
form
ance
ver
sus
3-h
po
st-e
xer
cise
CO
N:
15
min
seat
ed
Bu
chh
eit
etal
.[5
8]
Ad
ult
cycl
ists
(10
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
1-k
mcy
clin
g
tim
etr
ial
in
35
�C,
40
%
hu
mid
ity
.
Rep
eate
d
20
min
late
r
CW
I:5
min
in1
4�C
tom
idst
ern
alle
vel
,
seat
ed
7.5
min
po
st-
exer
cise
Tim
e-tr
ial
aver
age
po
wer
and
tim
e,H
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aria
bil
ity
,
HR
reco
ver
y,
core
tem
per
atu
re,
per
ceiv
ed
reco
ver
y
20
min
CW
I::
HR
var
iab
ilit
y
ind
exes
bef
ore
and
afte
r
exer
cise
bo
ut
2,
and:
per
ceiv
edre
cov
ery
ver
sus
CO
NC
ON
:se
ated
rest
in
35
�Can
d4
0%
hu
mid
ity
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Bu
chh
eit
etal
.[8
9]
Eli
te-s
tan
dar
d
yo
uth
foo
tbal
lers
(5
[NS
])
Cro
sso
ver
con
tro
ltr
ial
Inte
rnat
ion
alcl
ub
foo
tbal
lm
atch
.
Rep
eate
dw
ith
in
48
h
CW
T:
2m
inin
85
–9
0�C
sau
na,
2m
inin
36
±2
�Cw
ater
tom
idst
ern
al
lev
el,
2m
inin
12
±1
�Cw
ater
to
ilia
ccr
est.
Per
form
ed3
tim
es,
seat
ed
12
–1
5h
po
st-
mat
ch
Fo
otb
all
mat
chlo
w,
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h,
and
ver
yh
igh
-in
ten
sity
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nin
g,
spri
nti
ng
,to
tal
dis
tan
ceco
ver
ed,
pea
k
vel
oci
ty,
nu
mb
ero
f
spri
nts
,n
um
ber
of
rep
eate
dsp
rin
tse
qu
ence
s
Wit
hin
48
hC
WT
::
low
-in
ten
sity
run
nin
g,
spri
nti
ng
,p
eak
run
nin
gv
elo
city
,n
um
ber
of
spri
nts
,an
dn
um
ber
of
rep
eat
spri
nt
seq
uen
ces
du
rin
gm
atch
2v
ersu
s
CO
N
CO
N:
no
trea
tmen
t
Co
ffey
etal
.
[84
]
Hig
hly
acti
ve
ind
ivid
ual
and
team
spo
rtp
lay
ers
(14
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Tre
adm
ill
run
sto
exh
aust
ion
at
12
0%
and
90
%o
fp
eak
run
nin
gsp
eed
).
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eate
d
*3
.5h
late
r
CW
T:
1m
inin
10
�C,
2m
inin
42
�C.
Rep
eate
d3
tim
esto
ilia
ccr
est,
stan
din
g
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edia
tely
po
st-e
xer
cise
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n-t
o-e
xh
aust
ion
tim
es,
HR
,L
a,b
loo
dp
H,
RP
E
reco
ver
y
*3
.5h
CW
T:;
po
st-e
xer
cise
La
ver
sus
CO
N.:
per
cep
tio
n
of
reco
ver
yv
ersu
sA
CT
and
CO
NA
CT
:;
po
st-
exer
cise
La
ver
sus
CO
N
AC
T:
15
min
run
at
40
%V
O2m
ax
CO
N:
15
-min
stan
din
g
Co
rtis
etal
.
[92
]
Mil
itar
y
per
son
nel
(8
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
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bm
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al
incr
emen
tal
trea
dm
ill
run
nin
g
(49
5m
inat
6,
8,
10
,1
2k
m/
h).
Rep
eate
d
*6
.5h
late
r
TW
I:2
0-m
insh
allo
w
wat
erae
rob
ic
exer
cise
at6
0%
HR
max.
Tem
per
atu
ren
ot
rep
ort
ed
*3
0m
in
po
st-e
xer
cise
CM
Jan
dre
pea
tju
mp
test
.
Su
bm
axim
alin
crem
enta
l
run
nin
gH
R,
VO
2,
VC
O2,
ven
tila
tio
n,
rect
us
fem
ori
s
per
cen
tO
2sa
tura
tio
n,
and
La.
Per
cep
tio
no
f
reco
ver
y,
RE
ST
Q,m
usc
le
sore
nes
s,R
PE
*6
.5h
TW
I::
per
cep
tio
no
f
reco
ver
yv
ersu
sC
ON
EM
S:
20
min
on
qu
adri
cep
s
EM
S::
per
cep
tio
no
f
reco
ver
yv
ersu
sC
ON
CO
N:
20
min
seat
ed
rest
Cro
we
etal
.
[61
]
Str
eng
th
trai
ned
and
team
spo
rts
pla
yer
s(1
7
[13
M,
4F
)
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
30
-sm
axim
al
cycl
ing
test
.
Rep
eate
d1
h
late
r
CW
I:1
5m
inin
13
–1
4�C
to
um
bil
icu
sle
vel
,
seat
ed
1m
inp
ost
-
exer
cise
Pea
kp
ow
er,
tim
eto
pea
k
po
wer
,to
tal
wo
rk,
HR
,
tym
pan
icte
mp
erat
ure
,
La,
blo
od
pH
,th
erm
al
dis
com
fort
,R
PE
1h
CW
I:;
rela
tiv
ep
eak
po
wer
,re
lati
ve
tota
l
wo
rk,
exer
cise
La,
and
pea
kex
erci
seH
Rv
ersu
s
CO
NC
ON
:1
5m
inse
ated
rest
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Daw
son
etal
.
[87
]
Sem
i-
pro
fess
ion
al
Au
stra
lian
foo
tbal
l
pla
yer
s(1
7
[M])
Sem
i-
ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
1W
AF
Lg
ame
per
wee
kfo
r
3w
eek
s
CW
T:
2m
inin
45
�Csh
ow
er,
1m
inin
12
�Cw
ater
stan
din
gw
aist
dee
p.
Per
form
ed5
ho
tan
d4
cold
imm
ersi
on
s
15
–2
0m
in
po
st-g
ame
for
3g
ames
6-s
cycl
ing
spri
nt
tota
l
wo
rk,
pea
kp
ow
er,
tim
e-
to-p
eak
po
wer
.V
erti
cal
jum
p,
sit
and
reac
h
flex
ibil
ity
,m
usc
le
sore
nes
s,in
terv
enti
on
ord
ero
fp
refe
ren
ce
15
,4
8h
CW
T:
no
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
TW
I:1
5m
ino
f
wal
kin
gin
28
�Csh
allo
wsw
imm
ing
po
ol
TW
I::
ver
tica
lju
mp
at
15
-hp
ost
-gam
ev
ersu
s
CO
N
ST
R:
15
min
of
stat
ic
stre
tch
ing
ST
R::
spri
nt
per
form
ance
at1
5-h
po
st-g
ame
ver
sus
CO
N
CO
N:
no
trea
tmen
tIn
terv
enti
on
ord
ero
f
pre
fere
nce
:T
WI,
ST
R,
CW
T,
CO
N
Est
on
and
Pet
ers
[21]
Un
iver
sity
stu
den
ts(1
5
[F])
Ran
do
mis
ed
con
tro
ltr
ial
Elb
ow
flex
ors
con
cen
tric
and
ecce
ntr
ic
max
imal
iso
kin
etic
con
trac
tio
ns
(8
sets
of
5re
ps)
CW
I:1
5m
inin
15
±1
�CE
xer
cise
dar
m
imm
erse
d(n
=8
)
Po
st-e
xer
cise
,
and
ever
y
12
hfo
r
3d
ays
Elb
ow
flex
or
MV
IC,
rela
xed
arm
ang
le,
up
per
-
arm
gir
th,
CK
,m
usc
le
sore
nes
s
24
,4
8,
72
hC
WI::
rela
xed
elb
ow
ang
lean
d;
CK
on
day
s2
and
3p
ost
-ex
erci
se
CO
N:
no
trea
tmen
t
(n=
7)
Fre
nch
etal
.
[85
]
Rec
reat
ion
al-
tore
gio
nal
-
lev
elru
gb
y
and
foo
tbal
l
pla
yer
s(2
6
[M])
Pai
r-m
atch
ed
con
tro
ltr
ial
Res
ista
nce
exer
cise
chal
len
ge
(6
sets
of
10
squ
ats
at1
00
%b
od
y
mas
s,1
ecce
ntr
icsq
uat
at1
RM
)
CW
T:
1m
inin
8–
10
�C,
3m
inin
37
–4
0�C
.4
cold
s
and
3h
ots
per
form
edse
ated
in
50
cmo
fw
ater
(n=
10
)
Wit
hin
10
min
po
st-e
xer
cise
10
-an
d3
0-m
spri
nts
,C
MJ,
rep
eat
CM
J,5
RM
squ
at,
mu
ltip
lan
arag
ilit
yte
st,
low
er-l
imb
RO
M,
thig
h
and
calf
gir
ths,
CK
,M
g,
mu
scle
sore
nes
s
0,
24
,4
8h
(no
blo
od
mar
ker
s
at4
8h
)
CW
T:;C
K(l
arg
eE
S)
at
24
-an
d4
8-h
po
st-
exer
cise
ver
sus
CO
N.;
Mg
du
rin
gth
e4
8-h
po
st-
exer
cise
ver
sus
CO
N.;
mu
scle
sore
nes
s1
-hp
ost
-
exer
cise
ver
sus
CO
N
CO
MP
:w
eari
ng
com
pre
ssio
nti
gh
ts
for
12
ho
ver
nig
ht
(n=
10
)
CO
MP
:;
thig
hg
irth
and:
30
msp
rin
tti
me
at4
8-h
po
st-e
xer
cise
ver
sus
CO
N
CO
N:
no
trea
tmen
t
(n=
6)
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Ham
lin
[88
]D
evel
op
men
t
rug
by
pla
yer
s
(20
[17
M,
3
F])
Ran
do
miz
ed
cro
sso
ver
tria
l
Rep
eat
spri
nt
test
(10
94
0m
spri
nts
on
30
s).
Rep
eate
d1
h
late
r
CW
T:
1m
inin
8–
10
�Cto
hip
lev
elst
and
ing
,
1m
inin
38
�Csh
ow
ero
nle
gs.
Rep
eate
d3
tim
es
Po
st-e
xer
cise
Rep
eat
spri
nt,
La,
HR
1h
CW
T:;
po
st-r
eco
ver
yL
a
and
exer
cise
2H
Rv
ersu
s
AC
T
AC
T:
6m
injo
gg
ing
on
gra
ssat
6.8
km
/
h
Ham
lin
[67
]D
evel
op
men
t
net
bal
lers
(20
[F])
Ran
do
miz
ed
con
tro
ltr
ial
20
-mm
ult
ista
ge
shu
ttle
run
foll
ow
edb
y
rep
eat
spri
nt
test
(69
5-,
10
-,an
d1
5-m
spri
nt
shu
ttle
s
on
30
s)
CW
I:1
min
in
8–
10
�Cw
ater
seat
ed,
1m
inin
air
stan
din
g.
Per
form
ed3
tim
es
on
leg
s(n
=8
)
Po
st-e
xer
cise
Rep
eat
spri
nt,
PO
MS
,L
a2
hC
WI:
No
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
CW
T:
1m
inin
8–
10
�Cw
ater
seat
ed,
1m
inin
38
�Csh
ow
er
stan
din
g.
Per
form
ed3
tim
es
on
leg
s(n
=7
)
CW
T:;
po
st-r
eco
ver
yL
a
ver
sus
CO
Nan
dC
WI
CO
N:
6m
inre
st
(n=
5)
Hey
man
etal
.[5
2]
Tra
ined
clim
ber
s(1
3
[F])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Sta
nd
ard
ized
ind
oo
rro
ck
clim
bin
gto
exh
aust
ion
.
Rep
eate
d
20
min
late
r
CW
I:5
min
in
15
±1
�Cw
ater
,
2m
inin
air
seat
ed.
Rep
eate
d3
tim
es
wit
har
ms
(ex
clu
din
gh
and
s)
imm
erse
d
Po
st-e
xer
cise
Cli
mb
ing
tim
e,n
um
ber
of
arm
mo
vem
ents
,h
and
gri
p
stre
ng
th,
HR
,m
ean
skin
tem
per
atu
re,
La,
ther
mal
sen
sati
on
,R
PE
20
min
CW
I::
clim
bin
g
per
form
ance
ver
sus
EM
S
and
CO
N,;
skin
tem
per
atu
rean
dth
erm
al
sen
sati
on
wh
enin
wat
er
ver
sus
CO
N
AC
T:
20
min
cycl
ing
at3
0–
40
Wan
d
50
–7
0rp
m
AC
T::
clim
bin
g
per
form
ance
ver
sus
EM
S
and
CO
N,
larg
est;
inL
a
du
rin
gre
cov
ery
,:
ther
mal
sen
sati
on
du
rin
g
reco
ver
yV
ersu
sC
WI,
EM
San
dC
ON
EM
S:
20
min
on
fore
arm
flex
or
mu
scle
s
CO
N:
seat
edre
st
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Hig
gin
set
al.
[65
]
Wel
ltr
ain
ed
rug
by
un
ion
pla
yer
s(2
6
[M])
Ran
do
miz
ed
con
tro
ltr
ial
1ru
gb
yu
nio
n
gam
ean
d2
trai
nin
gs
per
wee
kfo
r
4w
eek
s
CW
I:5
min
in
10
–1
2�C
toab
ov
e
wai
stli
ne
(n=
7)
Po
st-g
ames
and
trai
nin
gs
for
4w
eek
s
Rep
eat
spri
nt,
30
0-m
spri
nt.
Per
ceiv
edd
egre
eo
fre
st,
tig
htn
ess,
effe
ctiv
enes
so
f
trea
tmen
t
Inw
eek
foll
ow
ing
the
fou
rth
gam
e
CW
I:;
rep
eate
dsp
rin
t
per
form
ance
(mo
der
ate
ES
)p
ost
-in
terv
enti
on
and
:ti
gh
tnes
s2
-day
sp
ost
-
gam
esv
ersu
sC
ON
CW
T:
1m
inin
10
–1
2�C
,1
min
in
38
–4
0�C
.
Alt
ern
ated
cold
and
ho
tfo
r7
min
,w
ater
dep
thn
ot
rep
ort
ed
(n=
8)
CW
T::
30
0-m
spri
nt
per
form
ance
(mo
der
ate
ES
)p
ost
-in
terv
enti
on
and
:d
egre
eo
fre
stv
ersu
s
CO
N
CO
N:
pas
siv
ere
st
(n=
11
)
Ho
wat
son
etal
.[4
3]
Rec
reat
ion
ally
acti
ve
(16
[M])
Ran
do
miz
ed
con
tro
ltr
ial
Dro
pju
mp
s(5
sets
of
20
jum
ps)
.
Rep
eate
d
14
–2
1d
ays
late
r
CW
I:1
2m
inin
15
±1
�Cto
ilia
c
cres
t.P
ost
ure
no
t
rep
ort
ed(n
=8
)
Imm
edia
tely
,
24
,4
8,
and
72
hp
ost
-
exer
cise
Kn
eeex
ten
sors
MV
IC,
mid
-th
igh
gir
th,
CK
,
mu
scle
sore
nes
s
0,
24
,4
8,
72
,
96
h
CW
I:n
osi
gn
ifica
nt
effe
ct
on
any
mea
sure
sv
ersu
s
CO
N
CO
N:
12
min
seat
ed
rest
(n=
8)
Ing
ram
etal
.
[44
]
Tea
mg
ame
exp
erie
nce
(11
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Sim
ula
ted
team
spo
rtex
erci
se
(49
20
min
of
inte
rmit
ten
t
run
nin
g),
then
a
20
-mm
ult
ista
ge
shu
ttle
run
test
CW
I:5
min
in1
0�C
wat
er,
2.5
min
ou
t
of
wat
erse
ated
,
5m
inin
10
�Cw
ater
.P
erfo
rmed
to
um
bil
icu
s.P
ost
ure
inw
ater
no
t
rep
ort
ed
Imm
edia
tely
and
24
h
po
st-e
xer
cise
Leg
exte
nsi
on
,le
gfl
exio
n,
and
hip
flex
ion
MV
IC.
Rep
eat
spri
nt,
CK
,C
RP
,
hae
mo
glo
bin
,
hae
mat
ocr
it,
chan
ge
in
pla
sma
vo
lum
e,m
usc
le
sore
nes
s
48
hC
WI::
leg
exte
nsi
on
and
flex
ion
MV
IC,
and;
mu
scle
sore
nes
sat
48
-h
po
st-e
xer
cise
ver
sus
CO
N
and
CW
T.:
rep
eate
d
spri
nt
abil
ity
ver
sus
CO
N
and
CW
T
CW
T:
2m
inin
10
�C,
2m
inin
40
�C.
Per
form
ed3
tim
es
tou
mb
ilic
us.
Po
stu
ren
ot
rep
ort
ed
CW
T:;
mu
scle
sore
nes
sat
24
hp
ost
-ex
erci
sev
ersu
s
CO
N
CO
N:
15
min
seat
ed
rest
Jak
eman
etal
.[5
9]
Ph
ysi
call
y
acti
ve
(18
[F])
Ran
do
miz
ed
con
tro
ltr
ial
CM
J(1
0se
tso
f
10
jum
ps)
CW
I:1
0m
inin
10
±1
�Cto
sup
erio
ril
iac
cres
t
seat
ed
Wit
hin
10
min
po
st-e
xer
cise
Qu
adri
cep
sm
axim
al
iso
kin
etic
con
cen
tric
stre
ng
th,
CK
,li
mb
sore
nes
s
1,
24
,4
8,
72
,
96
h
CW
I:n
osi
gn
ifica
nt
effe
ct
on
any
mea
sure
sv
ersu
s
CO
N
CO
N:
No
trea
tmen
t
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Kin
gan
d
Du
ffiel
d
[68
]
Tra
ined
net
bal
lers
(10
[F])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Sim
ula
ted
net
bal
l
circ
uit
inv
olv
ing
rep
eat
spri
nts
.
Rep
eate
d2
4h
late
r
CW
I:5
min
in
9±
2�C
wat
erto
ilia
ccr
est,
2.5
min
inai
rse
ated
.
Per
form
edtw
ice.
Po
stu
rein
wat
ern
ot
rep
ort
ed
Po
st-e
xer
cise
Net
bal
lci
rcu
itti
me,
10
-m
spri
nt,
20
-mre
pea
tsp
rin
t,
rep
eat
CM
J,H
R,
bo
dy
mas
s,sk
inte
mp
erat
ure
,
La,
bic
arb
on
ate,
blo
od
pH
,m
usc
leso
ren
ess,
RP
E
24
hC
WI::
rep
eate
dC
MJ
per
form
ance
(lar
ge
ES
)
ver
sus
CO
N
CW
T::
rep
eate
dsp
rin
t
per
form
ance
(lar
ge
ES
)
ver
sus
CO
N.;
La
po
st-
inte
rven
tio
nv
ersu
sA
CT
CW
T:
1m
inin
10
±1
�Cw
ater
to
ilia
ccr
est,
2m
inin
39
±2
�Csh
ow
er.
Per
form
ed5
tim
es
Po
stu
ren
ot
rep
ort
ed
AC
T::
po
st-i
nte
rven
tio
n
HR
and
RP
E,
and:
mu
scle
sore
nes
sp
re-
exer
cise
2v
ersu
sC
WI,
CW
Tan
dC
ON
AC
T:
15
min
exer
cise
at4
0%
v-V
O2m
ax.
Ex
erci
se
mo
de
no
tre
po
rted
CO
N:
Per
form
ance
retu
rned
tob
asel
ine
CO
N:
15
min
seat
ed
rest
Kin
ug
asa
and
Kil
din
g
[57
]
Yo
uth
foo
tbal
lers
(28
[NS
])
Ran
do
miz
ed
cro
sso
ver
tria
l
90
-min
foo
tbal
l
gam
e
CW
Ian
dA
CT
:1
min
in1
2�C
wat
erto
mid
ster
nal
lev
el
seat
ed,
2m
in
cycl
ing
at
90
–1
10
W.
Per
form
ed3
tim
es
Po
st-g
ame
CM
J,re
stin
gH
R,
tym
pan
ic
tem
per
atu
re,
tota
lq
ual
ity
reco
ver
ysc
ale,
leg
hea
vin
ess,
ther
mal
sen
sati
on
0,
24
hC
WI
and
AC
T::
per
ceiv
ed
qu
alit
yo
fre
cov
ery
po
st-
inte
rven
tio
nv
ersu
sS
TR
and
CW
I(m
od
erat
eE
S).
Per
ceiv
edli
gh
ter
leg
s
24
-hp
ost
-ex
erci
sev
ersu
s
ST
R(m
od
erat
eE
S).;
tym
pan
icte
mp
erat
ure
(lar
ge
ES
)p
ost
-
inte
rven
tio
nv
ersu
sS
TR
.
;th
erm
alse
nsa
tio
n(v
ery
larg
eE
S)
po
st-
inte
rven
tio
nv
ersu
sS
TR
CW
T:
1m
inin
12
�Cw
ater
tom
idst
ern
al
lev
else
ated
,2
min
in3
8�C
sho
wer
.
Per
form
ed3
tim
es
ST
R:
7m
ino
fst
atic
stre
tch
ing
,le
gs
abo
ve
hea
rtfo
r
2m
in
CW
T:;
tym
pan
ic
tem
per
atu
re(l
arg
eE
S)
po
st-i
nte
rven
tio
nv
ersu
s
ST
R.;
ther
mal
sen
sati
on
(mo
der
ate
ES
)an
dle
g
hea
vin
ess
po
st-
inte
rven
tio
nv
ersu
sS
TR
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Ku
lig
ow
ski
etal
.[4
5]
Un
iver
sity
stu
den
ts(5
6
[28
M,
28
F])
Ran
do
miz
ed
con
tro
ltr
ial
No
n-d
om
inan
t
arm
elb
ow
flex
or
ecce
ntr
ic
con
trac
tio
ns
(5
sets
of
10
rep
sat
[1
RM
con
cen
tric
)
CW
I:2
4m
inin
13
�C.
Ex
erci
sed
arm
imm
erse
dto
mid
-del
toid
lev
el
(n=
14
)
Imm
edia
tely
,
24
,4
8,
and
72
hp
ost
-
exer
cise
Elb
ow
flex
or
MV
IC,
rest
ing
elb
ow
RO
M,
acti
ve
elb
ow
RO
M,
arm
sore
nes
s
24
,4
8,
72
,9
6h
CW
I::
rest
ing
elb
ow
flex
ion
,;a
rmso
ren
ess
ver
sus
CO
Nan
dH
WI
HW
I::
rest
ing
elb
ow
flex
ion
ver
sus
CO
N
HW
I:2
4m
inin
39
�C.
Ex
erci
sed
arm
imm
erse
dto
mid
-del
toid
lev
el
(n=
14
)
CW
T::
rest
ing
elb
ow
flex
ion
,;a
rmso
ren
ess
ver
sus
CO
Nan
dH
WI
CW
T:
3m
inH
WI,
1m
in
CW
I:p
erfo
rmed
6
tim
es(n
=1
4)
CO
N:
no
trea
tmen
t
(n=
14
)
Lan
ean
d
Wen
ger
[53
]
Ph
ysi
call
y
acti
ve
(10
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
18
min
of
hig
h-
inte
nsi
ty
inte
rmit
ten
t
spri
nt
cycl
ing
(12
95
s,
69
10
san
d
49
15
s
spri
nts
).
Rep
eate
d2
4h
late
r
CW
I:1
5m
inin
15
�C,
leg
imm
ersi
on
.P
ost
ure
no
tre
po
rted
Po
st-e
xer
cise
Cy
clin
gto
tal
wo
rk2
4h
CW
I,A
CT
and
MA
S::
cycl
ing
tota
lw
ork
ver
sus
CO
N
AC
T:
15
min
cycl
ing
at3
0%
VO
2m
ax
MA
S:
15
min
leg
mas
sag
e
CO
N:
15
min
seat
ed
rest
Lu
met
al.
[93
]
Wel
ltr
ain
ed
tria
thle
tes
(9
[NS
])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Hig
h-i
nte
nsi
ty
inte
rval
run
nin
g
(89
3m
inat
90
%
v-V
O2m
ax)
TW
I:4
5–
60
min
swim
min
g,
4se
tso
f
59
10
0-m
free
sty
leat
85
–9
0%
of
1-k
m
tim
etr
ial
spee
d,
tem
per
atu
ren
ot
rep
ort
ed
10
hp
ost
-
exer
cise
Ru
nn
ing
tim
eto
fati
gu
eat
90
%v
-VO
2m
ax,
HR
,
CR
P,
La,
per
ceiv
ed
reco
ver
y,
RP
E
24
hT
WI::
run
nin
gti
me-
to-
fati
gu
e2
4-h
po
st-e
xer
cise
ver
sus
CO
N.;
CR
Pat
24
hp
ost
-ex
erci
sev
ersu
s
CO
N
CO
N:
45
–6
0m
ino
f
seat
edre
st
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Mo
ntg
om
ery
etal
.[3
]
Dev
elo
pm
ent
bas
ket
bal
lers
(29
[M])
Ran
do
miz
ed
con
tro
ltr
ial
Bas
ket
bal
l
tou
rnam
ent
(on
e4
8m
in
gam
ep
erd
ay
for
3d
ays)
CW
I:1
min
in1
1�C
wat
erto
mid
ster
nal
lev
el,
2m
inin
air.
Per
form
ed5
tim
es
(n=
10
)
Po
st-g
ame
for
3d
ays
20
msp
rin
t,v
erti
cal
jum
p,
bas
ket
bal
lli
ne
dri
ll,
bas
ket
bal
l-sp
ecifi
c
agil
ity
,si
t-an
d-r
each
flex
ibil
ity
,b
od
ym
ass,
mu
scle
sore
nes
s,
per
ceiv
edfa
tig
ue
Mo
rnin
gaf
ter
tou
rnam
ent
CW
I::
20
-msp
rin
t,
ver
tica
lju
mp
,b
ask
etb
all
lin
ed
rill
,an
dsi
tan
d
reac
hv
ersu
sC
ON
,;
mu
scle
sore
nes
san
d
fati
gu
ev
ersu
sC
ON
CO
MP
:w
eari
ng
low
er-l
imb
com
pre
ssio
n
gar
men
tso
ver
nig
ht
for*
18
h
CO
MP
::
ver
tica
lju
mp
and
bas
ket
bal
lli
ne-
dri
ll
ver
sus
CO
N.;
20
-m
spri
nt,
sit
and
reac
h,
mu
scle
sore
nes
san
d
fati
gu
ev
ersu
sC
ON
CO
N:
no
trea
tmen
t
(n=
10
)
Pad
do
n-J
on
es
and
Qu
igle
y
[50
]
6-m
on
ths
resi
stan
ce
trai
nin
g
exp
erie
nce
(8
[M])
Ran
do
miz
ed
con
tro
ltr
ial
64
ecce
ntr
ic
elb
ow
flex
ion
s
per
arm
(8se
ts
of
8re
ps
at
11
0%
of
con
cen
tric
1R
M)
CW
I:2
0m
inin
5±
1�C
wat
er,
60
min
inai
r.A
rm
(ex
clu
din
gh
and
)
imm
erse
d5
tim
es
Po
st-e
xer
cise
Elb
ow
flex
or
MV
ICan
d
iso
kin
etic
con
trac
tio
n,
arm
vo
lum
e,p
ress
ure
pro
be
mu
scle
sore
nes
s
0,
24
,4
8,
72
,9
6,
12
0,
14
4h
CW
I:n
osi
gn
ifica
nt
effe
ct
on
any
mea
sure
sv
ersu
s
CO
N
CO
N:
No
trea
tmen
t
for
no
n-i
mm
erse
d
arm
Par
ou
tyet
al.
[62
]
Nat
ion
al-l
evel
swim
mer
s
(10
[5M
,5
F])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
10
0-m
free
sty
le
swim
min
g
tim
e-tr
ial.
Rep
eate
d
30
min
late
r
CW
I:5
min
in
14
–1
5�C
to
sho
uld
ers
seat
ed
5m
inp
ost
-
exer
cise
10
0-m
free
sty
lesw
imm
ing
.
HR
pea
k,
chan
ge
and
var
iab
ilit
y.
La,
per
ceiv
ed
reco
ver
y,
RP
E
30
min
CW
I:;
swim
tim
e,H
R
chan
ge
and
pea
kv
ersu
s
CO
N.:
per
cep
tio
no
f
reco
ver
yan
d
par
asy
mp
ath
etic
acti
vit
y
ver
sus
CO
Nin
the
seco
nd
swim
CO
N:
5m
inse
ated
rest
Pei
ffer
etal
.
[27
]
Wel
ltr
ain
ed
cycl
ists
(10
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
25
-min
of
cycl
ing
at6
5%
VO
2m
ax,
then
a
4-k
mti
me-
tria
l
in3
5�C
.
Rep
eate
d
15
min
late
r
CW
I:5
min
in1
4�C
tom
idst
ern
alle
vel
seat
ed
5m
inp
ost
-
exer
cise
4-k
mti
me
tria
lti
me,
aver
age
po
wer
,V
O2
and
eco
no
my
.R
ecta
l
tem
per
atu
re
15
min
CW
I::
tim
e-tr
ial
2ti
me
and
aver
age
po
wer
,;
rect
alte
mp
erat
ure
pre
and
po
st-e
xer
cise
bo
ut
2
ver
sus
CO
NC
ON
:1
5m
inse
ated
rest
in3
5�C
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Pei
ffer
etal
.
[29
]
Tra
ined
cycl
ists
(12
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
Cy
clin
gti
me
to
exh
aust
ion
at
firs
tv
enti
lato
ry
thre
sho
ldp
ow
er
in4
0�C
CW
I:5
,1
0,
and
20
min
in
14
±0
�Cto
mid
ster
nal
lev
el
seat
ed
25
min
po
st-
exer
cise
Rig
ht
kn
eeex
ten
sors
MV
IC
and
iso
kin
etic
con
trac
tio
n,
rect
al
tem
per
atu
re,
mu
scle
tem
per
atu
re
55
min
CW
I:;
rect
alte
mp
erat
ure
ver
sus
CO
Nfr
om
all
imm
ersi
on
du
rati
on
s,
tren
dfo
rlo
ng
er
imm
ersi
on
sto
pro
du
ce
low
erre
ctal
tem
per
atu
res.
10
-an
d2
0-m
in
imm
ersi
on
s;
mu
scle
tem
per
atu
rem
ore
than
5m
inim
mer
sio
n
CO
N:
20
min
seat
ed
rest
in2
4�C
Pei
ffer
etal
.
[30
]
Wel
ltr
ain
ed
cycl
ists
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
90
min
of
cycl
ing
at8
0%
of
seco
nd
ven
tila
tory
thre
sho
ld
po
wer
,th
ena
16
.1-k
mti
me
tria
lin
32
.2±
0.7
�C
CW
I:2
0m
inin
14
±0
�Cto
mid
ster
nal
lev
el
seat
ed
25
min
po
st-
exer
cise
Rig
ht
kn
eeex
ten
sors
MV
IC,
fem
ora
lv
ein
dia
met
er,
skin
tem
per
atu
re,
rect
al
tem
per
atu
re
0,
45
,9
0m
inC
WI:;
MV
IC,
skin
tem
per
atu
re,
rect
al
tem
per
atu
re,
and
fem
ora
l
vei
nd
iam
eter
ver
sus
CO
NC
ON
:2
0m
inse
ated
rest
in2
4�C
Pei
ffer
etal
.
[34
]
Tra
ined
cycl
ists
(10
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
1-k
mcy
clin
g
tim
etr
ial
in
35
.0±
0.3
�C.
Rep
eate
d
20
min
late
r
CW
I:5
min
in1
4�C
tom
idst
ern
alle
vel
seat
ed
7.5
min
po
st-
exer
cise
1-k
mcy
clin
gti
me,
pea
k
po
wer
,av
erag
ep
ow
er.
Rig
ht
kn
eeex
ten
sor
max
imal
con
cen
tric
iso
kin
etic
torq
ue,
rect
al
tem
per
atu
re,
mu
scle
tem
per
atu
re
20
min
CW
I:;
mu
scle
tem
paf
ter
tim
e-tr
ial
2v
ersu
sC
ON
CO
N:
5m
inse
ated
rest
in3
5�C
Po
urn
ot
etal
.
[66
]
Eli
tefo
otb
all,
rug
by
and
vo
lley
bal
l
ath
lete
s(4
1
[M])
Ran
do
miz
ed
con
tro
ltr
ial
Ex
hau
stiv
e
inte
rmit
ten
t
exer
cise
pro
toco
l
(29
10
min
sep
arat
edb
y
10
min
)
CW
I:1
5m
inin
10
�Cto
ilia
ccr
est
seat
ed(n
=1
3)
Aft
erp
ost
-
exer
cise
mea
sure
s
Kn
eeex
ten
sor
MV
IC,
CM
J,3
0-s
row
ing
spri
nt
mea
np
ow
er,
CK
,L
DH
,
leu
cocy
tes,
neu
tro
ph
ils,
lym
ph
ocy
tes,
mo
no
cyte
s,
eosi
no
ph
ils,
ery
thro
cyte
s,
hae
mo
glo
bin
,
hae
mat
ocr
it,
sore
nes
s
0,
1,
24
h.
Blo
od
mar
ker
sat
1
and
24
h
CW
I::
MV
ICan
d;
in
leu
cocy
tes
ver
sus
CO
Nat
1h
.;
inC
Kv
ersu
sC
ON
at2
4h
CW
T:
1.5
min
in
10
�C,
1.5
min
in
42
�C.
Per
form
ed5
tim
esto
ilia
ccr
est
seat
ed(n
=1
0)
CW
T::
30
-sro
win
gsp
rin
t
and
LD
Hv
ersu
sC
ON
at
1h
HW
I:n
osi
gn
ifica
nt
effe
ct
on
any
mea
sure
sv
ersu
s
CO
N
HW
I:1
5m
inin
36�C
toil
iac
cres
tse
ated
(n=
9)
CO
N:
15
min
seat
ed
(n=
9)
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Ro
bey
etal
.
[46
]
Clu
ban
dju
nio
r
stat
e-le
vel
row
ers
(20
[12
M,
8F
])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
Sta
ircl
imb
ing
and
des
cen
din
g
run
nin
gta
sk
CW
T:
2m
inin
40
�Csh
ow
er,
1m
inin
12
�Cw
ater
wai
st
dee
p.
Per
form
ed5
tim
es.
Po
stu
ren
ot
rep
ort
ed
Imm
edia
tely
,
24
and
48
h
po
st-e
xer
cise
Ro
win
g2
km
erg
om
eter
,
max
imal
con
cen
tric
leg
exte
nsi
on
iso
kin
etic
torq
ue,
CK
,m
usc
le
sore
nes
s
CK
and
mu
scle
sore
nes
sat
0,
24
,4
8h
.A
ll
mea
sure
sat
72
h
CW
T:
No
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
ST
R:
No
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
ST
R:
15
min
stan
dar
diz
edst
atic
stre
tch
ing
CO
N:
15
min
seat
ed
rest
Ro
wse
llet
al.
[54
]
Un
der
17
stat
e-
lev
el
foo
tbal
lers
(13
[M])
Co
un
ter-
bal
ance
d
tria
l
Fo
otb
all
tou
rnam
ent
con
tain
ing
1
mat
chp
erd
ay
for
4d
ays
CW
I:1
min
in1
0�C
wat
erto
mid
ster
nal
lev
el,
1m
ino
ut
of
wat
erse
ated
.
Per
form
ed5
tim
es
(n=
6)
At
leas
t
10
min
po
st-
mat
chfo
r
4d
ays
Fo
otb
all
mat
chto
tal
and
hig
h-i
nte
nsi
tyru
nn
ing
dis
tan
ce,
tim
ein
HR
zon
es.
Leg
sore
nes
s,
per
ceiv
edle
gfa
tig
ue,
RP
E
1m
atch
per
day
for
4d
ays
CW
I::
tota
lru
nn
ing
dis
tan
cean
dti
me
in
mo
der
ate
HR
zon
e,;
leg
sore
nes
san
dg
ener
al
fati
gu
ev
ersu
sT
WI
TW
I:1
min
in3
4�C
tom
idst
ern
alle
vel
,
1m
ino
ut
of
wat
er
seat
ed.
Per
form
ed5
tim
es(n
=7
)
Ro
wse
llet
al.
[70
]
Un
der
17
stat
e-
lev
el
foo
tbal
lers
(13
[M])
Co
un
ter-
bal
ance
d
tria
l
Fo
otb
all
tou
rnam
ent
con
tain
ing
1
mat
chp
erd
ay
for
4d
ays
CW
I:1
min
in1
0�C
wat
erto
mid
ster
nal
lev
el,
1m
ino
ut
of
wat
erse
ated
.
Per
form
ed5
tim
es
(n=
6)
At
leas
t
10
min
po
st-
mat
chfo
r
4d
ays
Rep
eate
dsp
rin
t,C
MJ.
5-m
insu
bm
axim
alru
ns
HR
and
RP
E.
Fat
tyac
id
bin
din
gp
rote
in,
CK
,
LD
H,
Mg
,IL
-1b
,IL
-6,
IL-1
0,
per
ceiv
edre
cov
ery
90
-min
pre
-
mat
chan
d2
2-h
po
stfi
nal
mat
ch
CW
I:N
osi
gn
ifica
nt
effe
ct
on
any
mea
sure
sv
ersu
s
TW
I
TW
I:1
min
in3
4�C
tom
id-s
tern
alle
vel
,
1m
ino
ut
of
wat
er
seat
ed.
Per
form
ed5
tim
es(n
=7
)
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Say
ers
etal
.
[91
]
Un
der
18
stat
e-
lev
elfi
eld
-
ho
ckey
pla
yer
s(1
4
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Cy
clin
g3
0-s
Win
gat
e
erg
om
eter
test
.
Rep
eate
d
12
min
late
r
CW
T:
3.5
min
in
38
�C,
0.5
min
in
15
�C.
Per
form
ed3
tim
esto
jug
ula
r
no
tch
1m
inp
ost
-
exer
cise
Win
gat
ep
eak
po
wer
,
aver
age
po
wer
,to
tal
wo
rk,
and
po
wer
dec
lin
e.
HR
,b
loo
dp
ress
ure
,L
a,
per
ceiv
edfa
tig
ue
13
min
CW
T:
tren
dfo
r:
aver
age
po
wer
and
tota
lw
ork
ver
sus
CO
N,:
HR
du
rin
g
reco
ver
yv
ersu
sC
ON
,;
La
inre
cov
ery
and
po
st-
exer
cise
2v
ersu
sC
ON
,;
fati
gu
ev
ersu
sC
ON
and
AC
T
AC
T:
12
min
cycl
ing
at1
20
–1
30
bp
m
CO
N:
12
min
seat
ed
rest
AC
T:
tren
dfo
r:
aver
age
po
wer
and
tota
lw
ork
ver
sus
CO
N,:
HR
in
reco
ver
yan
dex
erci
se2
ver
sus
CO
Nan
dC
WT
,;
La
inre
cov
ery
and
po
st-
exer
cise
2v
ersu
sC
ON
Sch
nie
pp
etal
.[6
3]
Hig
hly
trai
ned
cycl
ists
(10
[NS
])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
0.2
-mil
ecy
clin
g
spri
nt.
Rep
eate
d
15
min
late
r
CW
I:1
5m
inin
12
�Cto
ilia
ccr
est.
Po
stu
ren
ot
rep
ort
ed
Po
st-e
xer
cise
Cy
clin
gsp
rin
tav
erag
e
po
wer
,m
axim
alp
ow
er,
tim
eto
max
imal
po
wer
,
HR
15
min
CW
I:;
pea
kp
ow
er,
aver
age
po
wer
and
HR
in
spri
nt
2v
ersu
sC
ON
CO
N:
15
min
seat
ed
rest
Sel
lwo
od
etal
.[4
9]
Un
trai
ned
adu
lts
(40
[11
M,
29
F])
Ran
do
miz
ed
do
ub
le-
bli
nd
tria
l
No
n-d
om
inan
t
ecce
ntr
icle
g
exte
nsi
on
s(5
sets
of
10
rep
s
at1
20
%o
f
con
cen
tric
1R
M)
CW
I:1
min
in
5±
1�C
to
ante
rio
rsu
per
ior
ilia
csp
ine
stan
din
g,
1m
ino
ut
of
wat
er.
Per
form
ed3
tim
es
Po
st-e
xer
cise
Qu
adri
cep
sM
VIC
,
1-l
egg
edh
op
for
dis
tan
ce,
thig
hci
rcu
mfe
ren
ce,
CK
,
alg
om
eter
pre
ssu
rele
g
sore
nes
s,p
erce
ived
leg
sore
nes
s
24
,4
8,
72
hC
WI:
No
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
TW
I
TW
I:1
min
in
24
±1
�Cto
ante
rio
rsu
per
ior
ilia
csp
ine
stan
din
g,
1m
ino
ut
of
wat
er.
Per
form
ed3
tim
es
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Sta
cey
etal
.
[60
]
Hab
itu
ally
acti
ve
adu
lts
(9[M
])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
39
50
kJ
all
ou
t
cycl
ing
bo
uts
sep
arat
edb
y
20
min
CW
I:1
0m
inin
10
�Cto
nec
kle
vel
seat
ed
5m
inp
ost
-
exer
cise
for
3b
ou
ts
50
kJ
cycl
ing
bo
ut,
La,
IL-
6,
tota
lle
uk
ocy
tes,
neu
tro
ph
ils,
lym
ph
ocy
tes,
per
ceiv
edle
gen
erg
y,
leg
sore
nes
s,p
erce
ived
leg
reco
ver
y,
RP
E
20
-,4
0-,
10
0-m
in
po
st-fi
rst-
exer
cise
bo
ut
CW
I::
tota
lle
uk
ocy
tes,
neu
tro
ph
ils
and
per
ceiv
ed
leg
reco
ver
yat
1-h
po
st-
exer
cise
ver
sus
CO
Nan
d
AC
T.:
neu
tro
ph
ils
du
rin
gex
erci
sean
d;
lym
ph
ocy
tes
at1
-hp
ost
-
exer
cise
ver
sus
CO
N
AC
T:
10
min
cycl
ing
at5
0W
CO
N:
10
min
lyin
g
sup
ine
AC
T:
no
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
Sta
nle
yet
al.
[71
]
En
du
ran
ce
trai
ned
cycl
ists
(18
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
60
min
of
hig
h-
inte
nsi
ty
cycl
ing
sess
ion
(89
4m
inat
80
%p
eak
po
wer
)
CW
I:5
min
in1
4�C
tosh
ou
lder
s
20
min
po
st-
exer
cise
Wo
rk-b
ased
cycl
ing
tim
e-
tria
l(7
5%
pea
k
po
wer
91
5m
in),
HR
,
card
iac
par
asy
mp
ath
etic
acti
vit
y(H
Rv
aria
bil
ity
).
Per
ceiv
edfa
tig
ue,
men
tal
reco
ver
y,
leg
sore
nes
s,
ph
ysi
cal
reco
ver
y
3.2
5h
CW
I::
card
iac
par
asy
mp
ath
etic
acti
vit
y
and
per
ceiv
edre
cov
ery
ver
sus
CO
N.;
leg
sore
nes
sv
ersu
sC
ON
CW
T:
1m
inin
14
�C,
2m
inin
36
�C.
Per
form
ed4
cold
and
3h
ot
imm
ersi
on
sto
sho
uld
ers
CW
T::
card
iac
par
asy
mp
ath
etic
acti
vit
y
and
per
ceiv
edre
cov
ery
ver
sus
CO
N.;
leg
sore
nes
sv
ersu
sC
ON
CO
N:
10
min
seat
edre
st
Tak
ahas
hi
etal
.[4
7]
Lo
ng
-dis
tan
ce
run
ner
s(1
0
[M])
Co
ntr
ol
tria
lD
ow
nh
ill
(-
10
%g
rad
ien
t)
trea
dm
ill
run
nin
g
(39
5m
inat
par
tici
pan
ts
5,0
00
m
per
son
alb
est
spee
d)
TW
I:3
0m
ino
f
ran
do
mly
com
bin
ed
aqu
aex
erci
ses
in
29
±1
�C(n
=5
)
Imm
edia
tely
,
24
and
48
h
po
st-e
xer
cise
Max
imal
leg
pre
ssp
ow
er,
wh
ole
-bo
dy
reac
tio
n
tim
e,si
t-an
d-r
each
flex
ibil
ity
,st
rid
ele
ng
th,
ank
leR
OM
,m
usc
le
stif
fnes
s,C
K,
mu
scle
sore
nes
s
24
,4
8,
72
hT
WI::
leg
mu
scle
po
wer
24
-hp
ost
-ex
erci
se,;
calf
stif
fnes
san
dso
ren
ess
ver
sus
CO
N
CO
N:
no
trea
tmen
t
(n=
5)
Tes
sito
re
etal
.[9
4]
Jun
ior
pro
fess
ion
al
elit
efo
otb
all
pla
yer
s(1
2
[NS
])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
10
0m
ino
f
stan
dar
diz
ed
foo
tbal
ltr
ain
ing
TW
I:2
0m
ino
f
shal
low
wat
er
aero
bic
exer
cise
s,
tem
per
atu
ren
ot
rep
ort
ed
Po
st-e
xer
cise
Sq
uat
jum
p,
CM
J,b
ou
nce
jum
p,1
0-m
spri
nt,
mu
scle
sore
nes
s,R
PE
4.5
hT
WI:
No
sig
nifi
can
tef
fect
on
any
mea
sure
sv
ersu
s
CO
N
AC
T:;
mu
scle
sore
nes
s
ver
sus
CO
Nan
dT
WI
AC
T:
20
min
of
low
-
inte
nsi
tyd
ry
aero
bic
exer
cise
s
EM
S:;
mu
scle
sore
nes
s
ver
sus
CO
Nan
dT
WI
EM
S:
20
min
on
qu
adri
cep
s
CO
N:
20
min
seat
ed
rest
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Tes
sito
re
etal
.[9
5]
Wel
ltr
ain
ed
futs
alp
lay
ers
(10
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Fri
end
lyfu
tsal
gam
e
TW
I:2
0m
ino
f
aero
bic
wal
kin
g,
jog
gin
gan
d
run
nin
gin
30
�Cw
ater
.W
ater
dep
th
of
1.2
0m
30
min
po
st-
exer
cise
CM
J,b
ou
nce
jum
p,
10
-m
spri
nt,
cort
iso
l,
adre
nal
ine,
no
rad
ren
alin
e,
slee
pd
ura
tio
nan
d
dis
turb
ance
s,m
usc
le
sore
nes
s,an
dp
erce
ived
reco
ver
y
5h
(per
form
ance
test
s,co
rtis
ol,
sore
nes
s,an
d
per
ceiv
ed
reco
ver
y),
20
h
(ad
ren
alin
e,
no
rad
ren
alin
e,
slee
pan
d
sore
nes
s
TW
I::
per
cep
tio
no
f
reco
ver
yv
ersu
sC
ON
and
AC
T
EM
S::
per
cep
tio
no
f
reco
ver
yv
ersu
sC
ON
and
AC
T
AC
T:
20
min
low
-
inte
nsi
tyae
rob
ic
exer
cise
EM
S:
20
min
on
qu
adri
cep
s
CO
N:
20
min
seat
ed
rest
Vai
leet
al.
[55
]
Wel
ltr
ain
ed
cycl
ists
(10
[M])
Ran
do
miz
ed
cro
sso
ver
tria
l
15
min
of
cycl
ing
at7
5%
pea
k
aero
bic
po
wer
,
then
a1
5-m
in
tim
etr
ial
in
34
.0�C
.
Rep
eate
d
55
min
late
r
CW
I:1
min
in1
0�C
tosh
ou
lder
sse
ated
,
2m
ino
ut
of
wat
er.
Per
form
ed5
tim
es
Po
st-e
xer
cise
Cy
clin
gti
me-
tria
lto
tal
wo
rk,
HR
,m
ean
bo
dy
tem
per
atu
re,
La,
ther
mal
sen
sati
on
,R
PE
55
min
CW
I:N
od
iffe
ren
ce
bet
wee
nC
WI
con
dit
ion
s.
:ti
me-
tria
lp
erfo
rman
ce
ver
sus
AC
T.;
HR
,m
ean
bo
dy
tem
per
atu
re(l
ow
er
wit
hco
lder
CW
I
tem
per
atu
res)
,th
erm
al
sen
sati
on
(lo
wer
wit
h
cold
erC
WI
tem
per
atu
res)
,R
PE
(CW
I
at1
0�C
,1
5�C
and
20
�Cco
nti
nu
ou
s)fo
llo
win
g
CW
Iv
ersu
sA
CT
.:
La
foll
ow
ing
CW
Iv
ersu
s
AC
T
CW
I:1
min
in1
5�C
tosh
ou
lder
sse
ated
,
2m
ino
ut
of
wat
er.
Per
form
ed5
tim
es
CW
I:1
min
in2
0�C
tosh
ou
lder
sse
ated
,
2m
ino
ut
of
wat
er.
Per
form
ed5
tim
es
CW
I:1
5m
inin
20
�Cto
sho
uld
ers
seat
ed
AC
T:
15
min
of
cycl
ing
at4
0%
VO
2m
ax
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Vai
leet
al.
[28
]
En
du
ran
ce
trai
ned
cycl
ists
(12
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Hig
h-i
nte
nsi
ty
cycl
ing
(66
max
imal
spri
nts
of
5–
15
s,
9m
ino
fti
me
tria
lef
fort
s).
On
cep
erd
ay
for
5d
ays
CW
I:1
4m
inin
15
�Cto
sho
uld
ers
up
rig
ht
Po
st-e
xer
cise
for
4d
ays
Cy
clin
gto
tal
wo
rk,
spri
nt
pea
kp
ow
er,
tim
e-tr
ial
aver
age
po
wer
,H
R,
rect
al
tem
per
atu
re,
RP
E
24
,4
8,
72
,9
6h
CW
I::
spri
nt
per
form
ance
on
day
s4
and
5an
dti
me-
tria
lp
erfo
rman
ceac
ross
5d
ays
ver
sus
CO
NC
WT
:1
min
in3
8�C
seat
ed,
1m
inin
15
�Cu
pri
gh
t.
Per
form
ed7
tim
es
tosh
ou
lder
s
CW
T::
spri
nt
per
form
ance
on
day
s4
and
5an
dti
me-
tria
lp
erfo
rman
ceac
ross
5d
ays
ver
sus
CO
N,;
core
tem
per
atu
re1
5m
in
po
st-i
mm
ersi
on
ver
sus
CO
Nan
dC
WT
HW
I:1
4m
inin
38
�Cto
sho
uld
ers
seat
ed
HW
I::
core
tem
per
atu
re
15
-min
po
st-i
mm
ersi
on
ver
sus
CW
Tan
dC
ON
CO
N:
14
min
seat
ed
rest
Vai
leet
al.
[48
]
Str
eng
th
trai
ned
(12
[M])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Ecc
entr
icle
g-
pre
ssp
roto
col
(5se
tso
f1
0
rep
sat
12
0%
of
con
cen
tric
1R
M,
2se
tso
f
10
rep
sat
10
0%
of
1R
M)
[25
,9
0]
CW
I:1
4m
inin
15
�Cto
sho
uld
ers
up
rig
ht
Imm
edia
tely
,
24
,4
8an
d
72
hp
ost
-
exer
cise
Sq
uat
MV
IC,
load
edsq
uat
jum
pm
axim
alp
ow
er,
thig
hci
rcu
mfe
ren
ce,
CK
,
Mg
,IL
-6,
LD
H,
mu
scle
sore
nes
s
0,
24
,4
8,
72
h.
No
Mg
or
IL-6
at4
8,
72
h
CW
I::
squ
atM
VIC
and
load
edsq
uat
jum
pp
eak
po
wer
ver
sus
CO
N.;
po
st-e
xer
cise
thig
h
circ
um
fere
nce
(sw
elli
ng
)
and
CK
at2
4-
and
72
-h
po
st-e
xer
cise
ver
sus
CO
N
Ex
p1
CO
N:
14
min
seat
ed
rest
Ex
p2
Str
eng
th
trai
ned
(11
[M])
HW
I:1
4m
inin
38
�Cto
sho
uld
ers
seat
ed
HW
I::
squ
atM
VIC
for
72
h,;
CK
at4
8-h
po
st-
exer
cise
ver
sus
CO
N
CO
N:
14
min
seat
ed
rest
Ex
p3
Str
eng
th
trai
ned
(15
[M])
CW
T:
1m
inin
38
�Cse
ated
,1
min
in
15
�Cu
pri
gh
t.
Per
form
ed7
tim
es
tosh
ou
lder
s
CW
T::
squ
atM
VIC
and
load
edsq
uat
jum
pp
eak
po
wer
for
72
hv
ersu
s
CO
N,;
po
st-e
xer
cise
thig
hci
rcu
mfe
ren
ce
(sw
elli
ng
)an
dp
erce
pti
on
of
pai
nfo
r7
2h
ver
sus
CO
N
CO
N:
14
min
seat
ed
rest
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Vai
leet
al.
[86
]
Rec
reat
ion
ally
trai
ned
(13
[4M
,9
F])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
Ecc
entr
icle
g-
pre
ssp
roto
col
(5se
tso
f1
0
rep
sat
14
0%
of
con
cen
tric
1R
M)
CW
T:
1m
inin
8–
10
�C,
2m
inin
40
–4
2�C
.
Per
form
ed5
tim
es
toan
teri
or
sup
erio
r
ilia
csp
ine.
Po
stu
re
no
tre
po
rted
45
sp
ost
-
exer
cise
Sq
uat
MV
IC,
jum
psq
uat
pea
kp
ow
er,
CK
,th
igh
vo
lum
e,m
usc
leso
ren
ess
0.2
5,2
4,4
8,7
2h
CW
T::
squ
atM
VIC
and
jum
psq
uat
per
form
ance
at2
4-
and
48
-hp
ost
-
exer
cise
ver
sus
CO
N.;
thig
hv
olu
me
imm
edia
tely
and
48
-h
po
st-C
WT
ver
sus
CO
N
CO
N:
15
min
seat
ed
rest
Vai
leet
al.
[19
]
En
du
ran
ce
trai
ned
cycl
ists
(10
[M])
Ran
do
miz
ed
cro
sso
ver
tria
l
15
min
of
cycl
ing
at7
5%
pea
k
po
wer
,th
en
15
-min
tim
e
tria
l.R
epea
ted
60
min
late
r
CW
I:1
5m
inin
15
�Cto
sho
uld
ers,
ver
tica
lp
ost
ure
5m
inp
ost
-
exer
cise
Cy
clin
gti
me-
tria
lto
tal
wo
rk,
HR
,re
ctal
tem
per
atu
re,
leg
and
fore
arm
blo
od
flo
w,
La
1h
CW
I::
cycl
ing
tim
e-tr
ial
per
form
ance
ver
sus
AC
T.
;re
ctal
tem
per
atu
rean
d
arm
blo
od
flo
wu
nti
len
d
of
exer
cise
bo
ut
2v
ersu
s
AC
T.;
leg
blo
od
flo
w
and
HR
un
til
star
to
f
exer
cise
bo
ut
2v
ersu
s
AC
T.:
leg
-to
-arm
blo
od
flo
wra
tio
un
til
star
to
f
exer
cise
bo
ut
2v
ersu
s
AC
T.:
La
imm
edia
tely
afte
rC
WI
ver
sus
AC
T
AC
T:
15
min
of
cycl
ing
at4
0%
pea
kp
ow
ero
utp
ut
Ver
sey
etal
.
[25
]
Tra
ined
cycl
ists
(11
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
75
-min
hig
h-
inte
nsi
ty
cycl
ing
pro
toco
l
(6se
tso
f
59
15
s
spri
nts
,
39
5m
inti
me
tria
ls).
Rep
eate
d
12
0m
inla
ter
CW
T:
1m
inin
38
�C,
1m
inin
15
�C.
Per
form
ed
for
6,
12
and
18
min
to
sho
uld
ers,
seat
ed
10
min
po
st-
exer
cise
Cy
clin
gsp
rin
tsto
tal
wo
rk
and
pea
kp
ow
er,
cycl
ing
tim
e-tr
ials
tota
lw
ork
,
HR
,re
ctal
tem
per
atu
re,
ther
mal
sen
sati
on
,w
ho
le-
bo
dy
fati
gu
e,m
usc
le
sore
nes
s,ef
fort
,
mo
tiv
atio
n,
RP
E,
con
dit
ion
ord
ero
f
pre
fere
nce
2h
CW
T:
6m
in;:
spri
nts
and
tim
e-tr
ials
tota
lw
ork
ver
sus
CO
N.
12
min
;:
spri
nts
tota
lw
ork
and
pea
kp
ow
er,
and;
mo
tiv
atio
nv
ersu
sC
ON
.
18
min
;:
effo
rtv
ersu
s
CO
N.
6,
12
and
18
min
;:
core
tem
per
atu
red
uri
ng
CW
Tan
d;
ther
mal
sen
sati
on
,w
ho
le-b
od
y
fati
gu
ean
dm
usc
le
sore
nes
sv
ersu
sC
ON
.1
2
and
18
min
;;
core
tem
per
atu
rep
re-e
xer
cise
2v
ersu
sC
ON
CO
N:
18
min
seat
ed
rest
Water Immersion Recovery for Athletes
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Ver
sey
etal
.
[90
]
Tra
ined
lon
g-
dis
tan
ce
run
ner
s(1
0
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
3,0
00
-mru
nn
ing
tim
e-tr
ial,
89
40
0m
run
nin
g
inte
rval
s
CW
T:
1m
inin
38
�C,
1m
inin
15
�C.
Per
form
ed
for
6,
12
and
18
min
to
sho
uld
ers,
seat
ed
10
min
po
st-
exer
cise
3,0
00
-mru
nn
ing
tim
e-tr
ial
tim
e,H
R,
calf
and
thig
h
gir
ths,
calf
and
thig
h
alg
om
eter
pai
n
thre
sho
lds,
ther
mal
sen
sati
on
,w
ho
le-b
od
y
fati
gu
e,m
usc
leso
ren
ess,
effo
rt,
mo
tiv
atio
n,
RP
E,
con
dit
ion
ord
ero
f
pre
fere
nce
2h
CW
T:
6m
in;;
3,0
00
-m
tim
e,m
oti
vat
ion
and
RP
E
ver
sus
CO
N.
12
min
;:
thig
hal
go
met
erp
ain
thre
sho
ldv
ersu
sC
ON
.
18
min
;;
mo
tiv
atio
nan
d
RP
Ev
ersu
sC
ON
.6
,1
2
and
18
min
;;
ther
mal
sen
sati
on
and
mu
scle
sore
nes
sv
ersu
sC
ON
CO
N:
18
min
seat
ed
rest
Vii
tasa
lo
etal
.[8
3]
Jun
ior
elit
e
trac
kan
d
fiel
dat
hle
tes
(14
[8M
,6
F])
Ran
do
miz
ed
cro
sso
ver
con
tro
ltr
ial
5tr
ack
-an
d-fi
eld
stre
ng
th/p
ow
er
trai
nin
g
sess
ion
sin
3d
ays.
Rep
eate
d
2w
eek
sla
ter
HW
I:2
0m
inin
37
�Cw
ith
jet
mas
sag
e.W
ater
dep
than
dp
ost
ure
no
tre
po
rted
20
–3
0m
in
po
st-e
ven
ing
trai
nin
gfo
r
3d
ays
Leg
exte
nsi
on
MV
CI,
jum
p
hei
gh
t,d
rop
jum
pg
rou
nd
con
tact
tim
e.R
epea
t
reb
ou
nd
jum
pte
st
aver
age
po
wer
,g
rou
nd
con
tact
tim
e,ju
mp
hei
gh
t.
CK
,M
g,
LD
H,
carb
on
ic
anh
yd
rase
-III
,u
rin
eu
rea
and
crea
tin
ine,
mu
scle
sore
nes
s
2m
orn
ing
and
1
afte
rno
on
po
st-
trai
nin
gb
lock
HW
I::
rep
eate
dre
bo
un
d
jum
pav
erag
ep
ow
eran
d
gro
un
dco
nta
ctti
me
ver
sus
CO
N.:
neu
rom
usc
ula
r
per
form
ance
cap
acit
y,
CK
,M
g,
LD
H,
and
uri
ne
ure
av
ersu
sC
ON
.;
mu
scle
sore
nes
sv
ersu
s
CO
N
CO
N:
no
trea
tmen
t
Yam
ane
etal
.
[51
]
Sed
enta
ry
stu
den
ts(6
[M])
Co
un
ter-
bal
ance
d
con
tro
ltr
ial
25
min
of
cycl
ing
at7
0%
VO
2m
ax.
4ti
mes
per
wee
kfo
r
4w
eek
s
CW
I:2
0m
inin
5±
1�C
,1
leg
imm
erse
d(f
oo
t
ou
t).
Per
form
eda
seco
nd
tim
eaf
ter
30
min
ou
to
fw
ater
Wit
hin
3m
in
po
st-
exer
cise
,4
tim
esp
er
wee
kfo
r
4w
eek
s
Cy
clin
g1
-an
d2
-leg
ged
VO
2m
ax
test
s:V
O2m
ax,
ven
tila
tio
nra
te,
CO
2
ou
tpu
t,v
enti
lato
ry
thre
sho
ld
Wit
hin
3d
ay’s
po
st-
trai
nin
g
CW
Ile
g:;
VO
2m
ax
and
cycl
ing
tim
ed
uri
ng
VO
2m
ax
test
ver
sus
CO
N
leg
.E
xp
1
CO
N:
un
trea
ted
leg
,
20
min
rest
inai
r
Ex
p2
Sed
enta
ry
stu
den
ts(6
[M])
Co
un
ter-
bal
ance
d
con
tro
ltr
ial
25
min
of
cycl
ing
at7
0%
VO
2m
ax.
4ti
mes
per
wee
kfo
r
6w
eek
s
CW
I:2
0m
inin
5±
1�C
,1
leg
imm
erse
d(f
oo
to
ut)
Wit
hin
3m
in
po
st-
exer
cise
,4
tim
esp
er
wee
kfo
r
6w
eek
s
Cy
clin
g1
-an
d2
-leg
ged
VO
2m
ax
test
s:V
O2m
ax,
ven
tila
tio
nra
te,
CO
2
ou
tpu
t,v
enti
lato
ry
thre
sho
ld.
Fem
ora
lar
tery
dia
met
er
Wit
hin
3d
ay’s
po
st-t
rain
ing
CW
Ile
g:;
VO
2m
ax,
ven
tila
tory
thre
sho
ldan
d
fem
ora
lar
tery
dia
met
er
ver
sus
CO
Nle
gC
ON
:u
ntr
eate
dle
g,
20
min
rest
inai
r
Ex
p3
Sed
enta
ry
stu
den
ts(1
1
[7M
,4
F])
Co
un
ter-
bal
ance
d
con
tro
ltr
ial
Han
dg
rip
con
trac
tio
n/
rela
xat
ion
exer
cise
(3se
ts
of
8R
M).
3
tim
esp
erw
eek
for
3w
eek
s
CW
I:2
0m
inin
10
±1
�C,
1lo
wer
arm
imm
erse
d
(han
do
ut)
Wit
hin
3m
in
po
st-
exer
cise
,3
tim
esp
er
wee
kfo
r
3w
eek
s
Max
imal
iso
met
ric
han
dg
rip
stre
ng
than
d
end
ura
nce
Wit
hin
3-d
ay’s
po
st-t
rain
ing
CW
Iar
m:;
han
dg
rip
stre
ng
than
den
du
ran
ce
ver
sus
CO
Nar
m
CO
N:
un
trea
ted
arm
,
20
min
rest
inai
r
N. G. Versey et al.
Author's personal copy
Ta
ble
1co
nti
nu
ed
Stu
dy
Par
tici
pan
ts
(n[s
ex])
Stu
dy
des
ign
Fat
igu
ing
exer
cise
pro
toco
l
Inte
rven
tio
ns
Inte
rven
tio
n
tim
ing
Ou
tco
me
mea
sure
sM
easu
rem
ent
tim
ing
aR
esu
lts
Ex
p4
Sed
enta
ry
stu
den
ts(1
6
[M])
Co
un
ter-
bal
ance
d
cro
sso
ver
con
tro
ltr
ial
No
n-d
om
inan
t
han
dg
rip
con
trac
tio
n/
rela
xat
ion
exer
cise
(3se
ts
of
8R
M).
3
tim
esp
erw
eek
for
3w
eek
s
CW
I:2
0m
inin
10
±1
�C,
no
n-
do
min
ant
low
er
arm
imm
erse
d
(han
do
ut,
n=
8)
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Water Immersion Recovery for Athletes
Author's personal copy
‘recovery’ and ‘exercise’. In addition, other published
articles known to the authors were retrieved, as well as
those obtained through reference list searches of the
retrieved studies. Studies were retained for inclusion in this
review if they contained original research examining the
effect of post-exercise water immersion on recovery of
performance in humans. The 53 studies that met these
criteria are summarised in Table 1.
2 Water Immersion Recovery Techniques
In all four water immersion recovery techniques, hydro-
static pressure acts on the body and its magnitude has a
linear relationship with both water density and immersion
depth according to the equation:
Phyd ¼ Patm þ g� p� h
where Phyd = water pressure (Pa), Patm = atmospheric
pressure (sea level *1,013 Pa), g = gravity (9.81 m/s2),
p = water density (1,000 kg/m3) and h = height of the
water (m) [15]. Therefore, hydrostatic pressure will be
influenced primarily by immersion depth, which usually
varies from waist to shoulder height with participants in a
seated or upright posture (Table 1). The hydrostatic pres-
sure at depths of 50, 100 and 150 cm would be 44, 81, and
118 mmHg, respectively, at sea level. If a consistent
hydrostatic pressure is maintained across all four tech-
niques, the key difference between techniques that may
affect performance recovery is water temperature. Other
factors may also vary between studies and influence the
findings, but they can be kept constant between techniques.
These include immersion duration, whether participants are
active or passive during immersion, the nature of the
fatiguing exercise and performance measures, the timing of
performance measures and water immersion, and the
environmental conditions (Table 1). Water immersion
techniques are typically performed within 30 min post-
exercise; however, some studies perform additional ses-
sions at regular intervals post-exercise (e.g. next day) [21,
43–48].
2.1 Cold Water Immersion (B20 �C)
2.1.1 Overview
CWI temperatures examined in the literature range from
5–20 �C; however, temperatures of either 5 �C [26, 49–51]
or 10–15 �C [3, 21, 26–30, 34, 43–45, 48, 51–66] are most
common. Total immersion time typically ranges from
3–20 min, consisting of either a single immersion
(5–20 min) [21, 26–30, 34, 43, 45, 48, 51, 53, 56, 58–66],
or multiple shorter immersions (1–5 min) separated by a
period of time out of the water (1–2.5 min) [3, 44, 49, 52,
54, 55, 57, 67, 68]. The immersion depth may vary from
waist [43, 49, 53, 56, 59, 61, 63, 65–69] to shoulder height
[3, 19, 27–30, 48, 54, 55, 57, 58, 60, 62, 64, 70, 71];
however, a number of studies have investigated the effect
of localized cooling of a body part (e.g. arm) [21, 45, 50–
52]. Participants are usually passive during immersion in
still water. CWI is increasingly being performed in pur-
pose-built pools at athletic recovery facilities; but, for
many athletes, the use of a bath or portable pool is more
practical, particularly when travelling. Pools may be con-
nected to portable chilling units that allow easier temper-
ature regulation. In cold climates, the water in rivers, lakes,
oceans and out of the tap may be B20 �C.
2.1.2 Performance Effects
The effect of post-exercise CWI on recovery of exercise
performance has been investigated in numerous studies
(Table 1). Most have reported that CWI can assist perfor-
mance recovery [3, 26–28, 44, 48, 52–56, 64], or has no
significant effect [21, 29, 34, 43, 45, 49, 50, 57–60, 66, 67,
70], while only a few have reported a detrimental effect on
recovery following fatiguing exercise [30, 51, 61–63].
Performance improvements have been reported for cycling
[27, 28, 53, 55], running [3, 26, 54, 64], climbing [52],
vertical jump [3, 68] and leg strength tests [44, 48, 56],
suggesting that the beneficial effects of CWI are not limited
to specific forms of exercise. Furthermore, these perfor-
mance improvements have been reported to last for min-
utes [26, 27, 52] to days [3, 28, 44, 48, 53–56, 64] post-
CWI, probably depending on the intensity and mode of
exercise [8, 72].
Most studies have compared CWI with a resting control
condition [26–30, 34, 43, 44, 48, 52, 53, 56, 58, 60–68, 71,
73]; however, in attempts to isolate the effects of water
temperature from those of water immersion, Sellwood et al.
[49] and Rowsell et al. [54, 70] compared CWI with TWI.
In Sellwood et al. [49] participants alternated 1 min in
water to the anterior superior iliac spine, and 1 min out of
the water, repeated three times. They found that CWI
(5 �C) had no significant effect on recovery of quadriceps
maximal isometric torque compared with TWI (24 �C) at
24, 48 or 72 h following eccentric leg extensions in
untrained adults. In contrast, Rowsell et al. [54, 70] (both
articles used the same participants) reported that CWI
(10 �C) reduced the decrement in running distance (CWI:
-5 %, TWI: -10 %) and heart rate across four matches of
a 4-day football (soccer) tournament compared with TWI
(34 �C) [54], but did not change repeated sprint test or
countermovement jump performance at 22 h post-tourna-
ment [70]. The water immersion consisted of alternating
1 min in water to midsternal level, 1 min out of the water,
N. G. Versey et al.
Author's personal copy
repeated 5 times. Although Sellwood et al. [49] reported no
significant effect on performance, the findings of Rowsell
et al. [54, 70] suggest that water temperature may influence
performance recovery in the days post-immersion. These
contrasting findings could be due to the different CWI
temperatures, types of exercise performed or subject pop-
ulations [8, 72].
Studies that have found CWI to assist recovery of
exercise performance have typically examined immersion
in 10–15 �C water (Table 1) [3, 26–28, 44, 48, 52–56, 64];
however, only two studies have attempted to determine the
ideal temperature by directly comparing different CWI
temperatures [26, 55]. In Yeargin et al. [26] participants
performed a 90-min moderate-intensity hilly trail run,
followed immediately by water immersion and then a
2-mile running race 15 min later. They reported no sig-
nificant difference in race performance following 12 min
CWI of the upper legs to shoulders in 14 �C (2 % faster)
compared with 5 �C; however, only performance following
immersion in 14 �C water was faster than control [6 %,
0.41 effect size (ES)], suggesting that CWI in 14 �C is
preferable to 5 �C for recovery of running performance. In
a more recent attempt to determine the ideal CWI tem-
perature, Vaile et al. [55] compared intermittent immer-
sions to shoulder level in 10, 15 and 20 �C water for 5 min
and continuous immersion in 20 �C for 15 min following
cycling. Although all CWI conditions helped maintain
subsequent (1 h later) cycling time-trial performance
(10 �C: -0.6 %, 15 �C: 0.4 %, 20 �C: -1.0 %, 20 �C
continuous: -0.6 %) compared with active recovery
(-4.1 ± 1.8 %), there were no significant differences in
performance between CWI conditions.
However, it is notable that the studies by both Yeargin
et al. [26] and Vaile et al. [55] were performed in warm-to-
hot environmental conditions (27 and 34 �C, respectively)
and the subsequent performance tests were conducted
within about 30-min post-CWI. Therefore, the findings
may not transfer to exercise in other environmental con-
ditions because CWI may have assisted subsequent per-
formance due to pre-cooling, as opposed to enhanced
recovery [38]. This suggestion is supported by the
decreases in body temperatures observed following CWI
and during subsequent exercise in both studies [26, 55].
Interestingly, Yeargin et al. [26] suggested that CWI in
5 �C may have cooled participants too much to allow
optimum performance 15 min later as they reported feeling
‘stiff and cold’. Furthermore, the performance effects in the
subsequent hours and days remain unknown and may differ
from the initial 30-min post-immersion. Based on the
combined findings of the scientific literature (Table 1),
CWI in 10–15 �C water appears most likely to assist
recovery of exercise performance; nevertheless, the find-
ings of Vaile et al. [55] suggest that CWI in temperatures
as warm as 20 �C might be as effective for recovery of
exercise performance in hot conditions.
In addition to water temperature, immersion duration
may influence the effect of CWI on recovery of perfor-
mance. Peiffer et al. [29] is the only study to have exam-
ined different CWI durations, comparing 5, 10 and 15 min
in 14 �C water to midsternal level on recovery of knee
extensor maximal isometric and isokinetic torque. How-
ever, none of the CWI durations accelerated performance
recovery, probably because testing was performed
10–25 min after CWI and therefore participants were still
too cold to perform anaerobic tests optimally. If partici-
pants had more time to adequately warm-up prior to testing
[37], or a prolonged aerobic test had been performed, the
results may have been different [38]. This point will be
discussed in more detail later in this section. Studies that
have found CWI can assist recovery of exercise perfor-
mance have typically used immersion durations of
5–15 min [3, 26–28, 44, 48, 52–56, 64], but these durations
are also common in studies not reporting a performance
benefit (Table 1) [21, 29, 34, 43, 58–63, 66, 70]. When
considering immersion duration, thought should also be
given to the practicality of performing CWI due to the
thermal discomfort experienced during immersion [25, 52,
55, 56]. Shorter immersion durations are probably more
tolerable for athletes, therefore increasing compliance;
although, this may not be optimal for recovery of perfor-
mance. Whether longer immersion durations provide
greater recovery benefits remains unknown at this stage.
The optimal CWI duration for recovery of performance
may also differ depending on the circumstances. It would
seem logical that immersion durations should be shorter in
colder water (within the previously discussed range of
10–15 �C) as less time would be required to have the same
cooling effect on the body [26, 55]. In addition, until
recently it was thought that athletes with higher subcuta-
neous adipose tissue levels experienced a slower decrease
in core temperature during CWI [74, 75], possibly due to
poor vascularization and thermal conductivity of adipose
tissue [76]. However, this understanding was based on the
responses of normothermic individuals during CWI [74,
75]. In contrast, athletes may commence water immersion
with elevated body temperatures due to prior exercise.
More recently, it has been found that subcutaneous adipose
tissue levels (12.9 ± 1.9 % vs. 22.3 ± 4.3 %) have no
significant effect on core body temperature cooling rates in
habitually active, hyperthermic individuals performing
post-exercise CWI (full body immersion in 8 �C) [77].
Lemire et al. [77] suggested this was due to any differences
in muscle insulation being reduced by a high residual
muscle blood flow and blood pooling post-exercise, and
exercise in the heat causing an increase in skin blood flow
and therefore a decrease in the effect of greater adipose
Water Immersion Recovery for Athletes
Author's personal copy
tissue insulation. These findings suggest that CWI duration
may be positively related to subcutaneous adipose tissue
levels when athletes are normothermic, but not when they
are hyperthermic, and immersion duration should be
altered accordingly.
The timing of CWI post-exercise may also influence any
effects on performance recovery; however, most studies
have commenced water immersion within 30-min post-
exercise (Table 1). To our knowledge, Brophy-Williams
et al. [64] is the only study to have compared the effect of
immediate, versus delayed CWI on recovery of exercise
performance. It was reported that 15 min in 15 �C water to
midsternal level provided greater recovery benefits in team
sport athletes when undertaken immediately compared
with 3 h post-exercise, but performing CWI 3 h post-
exercise was still likely to assist recovery. Performance
changes were measured 24 h after fatiguing exercise by the
Yoyo Intermittent Recovery test. Furthermore, some stud-
ies have investigated the effect of multiple CWI sessions in
the days following a single exercise bout [21, 43–45, 48]
probably because it was thought that multiple sessions
would be more likely to stimulate a physiological response
and therefore promote recovery than a single session [26,
27, 29, 30, 34, 50, 52, 53, 55–63, 67, 68]. It remains
uncertain whether this is the case as no study has conducted
a direct comparison, and the proportion of studies that find
performance benefits using each methodology is similar
(*40 %).
Conversely, most athletes train or compete once or twice
per day for many days in succession; therefore, studies
examining repeated post-exercise CWI use are likely to be
more sports-specific in design [3, 28, 51, 54, 65]. Vaile
et al. [28] used such a design and found that CWI for
14 min in 15 �C water to shoulder level following a high-
intensity cycling protocol performed daily for 4 days in
succession enhanced recovery compared with control.
Similar findings were also observed by Montgomery et al.
[3] and Rowsell et al. [54] during multiday team sport
tournaments, in which repeated post-exercise CWI
enhanced performance recovery. These combined findings
suggest that repeated post-exercise CWI are likely to
enhance performance recovery, possibly due to accumu-
lated fatigue from multiple exercise bouts [5, 28]. Con-
trasting findings were reported by Yamane et al. [51] in
four experiments summarized in Table 1; however, their
results should be interpreted with caution as the study used
a low number of sedentary adult participants and therefore
their findings may not transfer to trained athletes. It is
generally recognized that sports science research should be
performed on highly trained participants to increase
applicability to athletic populations [9, 78], as trained
athletes have been shown to have a reduced capacity for
adaptation and some different physiological responses
during and following training, compared with sedentary
adults [79–82]. Furthermore, the exercise protocols used by
Yamane et al. [51] were unlikely to have produced accu-
mulated fatigue, in some cases were not sports specific and,
additionally, only the exercised portion of the body was
immersed.
Studies investigating the use of CWI to accelerate
recovery have measured exercise performance at times
ranging from immediately post, to up to 7 days after the
completion of CWI (Table 1). The timing of performance
tests is likely to depend largely on the practical situation
being replicated, the time-course of the fatigue experi-
enced by participants and the time available to conduct
the research. Most studies that report CWI as having a
detrimental effect on recovery of performance have per-
formed high-intensity, explosive exercise tests within
45 min of completing CWI [30, 61–63]. However, CWI
has been shown to decrease internal body temperatures
following immersion [30], and it is recognized that ele-
vated internal body temperatures can improve sports
performance [37]. Therefore, to perform optimally, ath-
letes should not undertake CWI shortly before (\45 min)
high-intensity, explosive exercise unless an adequate
warm-up is completed to increase internal body temper-
atures. The CWI is effectively acting as pre-cooling for
the subsequent exercise, therefore longer duration per-
formance tests or tests performed in a warm-to-hot envi-
ronment may benefit more from the lower internal body
temperatures that can result from CWI [38, 39]. This
reduction in core temperature is the likely mechanism
behind studies, which have found that CWI can assist
recovery of performance in the heat, despite undertak-
ing exercise tests within 35 min of water immersion
[26, 27, 55].
2.2 Hot Water Immersion (C36 �C)
2.2.1 Overview
HWI is typically performed in temperatures C36 �C, with
immersion times examined in the literature ranging from
10–24 min [28, 45, 48, 66, 83]. A single full-body
immersion is usually performed; however, similar to CWI,
one study has examined the effect of localized heating of a
body part (arm) [45]. Participants are usually passive dur-
ing immersion, although underwater jets are often available
for massage [15, 83]. Hot pools may be more widely
available than cold pools as they might be part of a
swimming pool complex, and hot temperatures are easier to
achieve than cold temperatures in a home or hotel bath.
Similar to CWI, a bath or portable pool attached to a
heating unit may be more practical at some competition or
training venues.
N. G. Versey et al.
Author's personal copy
2.2.2 Performance Effects
Few studies have investigated the effect of HWI on
recovery of exercise performance [28, 45, 48, 66, 83],
and none have provided substantial evidence that HWI
may assist performance recovery. The first study was
performed by Viitasalo et al. [83] and found that 20 min
of warm (37 �C) underwater jet massage performed daily
for 3 days by junior elite track-and-field athletes,
improved maintenance of repeated jump test mean power
(0 %, p [ 0.05) compared with control (-10 %,
p \ 0.001), but had no significant effect on leg extension
maximal isometric strength or jump height across the
training block. A subsequent study by Kuligowski et al.
[45] found that following elbow flexor eccentric con-
tractions, immersion for 24 min in 39 �C water had no
significant effect on elbow flexor maximal isometric
contractions compared with control for up to 96 h [45].
While HWI was performed daily for 4 days, Kuligowski
et al. [45] only exercised and performed HWI on the
non-dominant arm elbow flexors of untrained partici-
pants; therefore (as discussed earlier), the applicability of
their findings to athletes performing sport-specific tasks
may be limited.
More recently, Vaile et al. [28] reported that daily
post-exercise immersion for 14 min in 38 �C water to the
shoulders had no significant effect on subsequent cycling
sprint or time-trial ability over 5 days compared with
control. However, in another study [48], the same
authors found that an identical HWI protocol improved
recovery of isometric squat force for 72-h post-exercise
(24 h: -12.8 %, 48 h: -10.1 %, 72 h: -3.2 %) com-
pared with control (24 h: -17.0 %, 48 h: -16.0 %, 72 h:
-9.8 %), but did not significantly affect loaded squat
jump maximal power, following an eccentric leg-press
protocol designed to induce muscle damage. Based on
the small number of studies in the area, it is unlikely
that post-exercise HWI has a significant effect on
recovery of subsequent exercise performance, despite a
range of fatiguing exercise protocols, and performance
tests having been examined in the literature. Therefore,
HWI is currently not recommended as a recovery tech-
nique for athletes. However, there is some suggestion
that HWI may improve recovery of isometric squat force
[48] and repeat rebound jump average power (without
improving jump height) [83] following muscle-damaging
exercise. While the investigated HWI protocols appear
unlikely to have a detrimental effect on performance,
if HWI causes an elevation in core temperature
during subsequent prolonged exercise (particularly in
hot environmental conditions), performance may be
compromised [39].
2.3 Contrast Water Therapy (Alternating C36
and B20 �C)
2.3.1 Overview
CWT is performed by alternating regularly between HWI
and CWI. Most published CWT protocols alternate 3–7
times between 1 min CWI and 1–2 min HWI, accumulat-
ing 6–15 min in the water [28, 48, 65, 66, 68, 84–86]. In
some studies, a hot shower is used instead of a hot pool [46,
57, 67, 87, 88], possibly to simulate a situation in which
athletes do not have access to this facility. In the literature,
there appears to be no consensus on whether CWT should
finish with HWI [44, 57, 66–68, 84, 86, 88] or CWI [28, 45,
46, 48, 65, 85, 87, 89], with roughly half of the protocols
finishing with either temperature. Participants are usually
passive during the water immersion; however, they are still
required to move between pools. The equipment or facili-
ties required to perform CWT may be relatively difficult to
obtain because both hot and cold water are required.
2.3.2 Performance Effects
To our knowledge, 20 studies have investigated the effect
of post-exercise CWT on recovery of exercise performance
(Table 1) [25, 28, 44–46, 48, 57, 65–68, 71, 84–91], with
only nine reporting beneficial effects [25, 28, 48, 65, 66,
68, 86, 89, 90]. Nonetheless, many of the studies reporting
beneficial effects on performance recovery have contained
similar CWT protocols [25, 28, 48, 65, 66, 86, 89, 90] that
differ notably from the protocols used in studies that do not
find a performance benefit [44–46, 57, 67, 71, 84, 85, 87,
88, 91], suggesting that certain protocols might be more
likely to enhance performance recovery. These protocols
typically alternate regularly between hot and cold water
(1–2 min immersions), contain a similar ratio of hot-to-
cold water immersion, involve full-body immersion and do
not use hot showers instead of a pool. Two of the studies
that found performance benefits were conducted by Vaile
et al. [28, 48] who used different modes of exercise, but
identical water immersions that led to the CWT protocol
suggestions above (alternating 1 min in 38 �C, and 1 min
in 15 �C, for 14 min immersed to shoulder level). Vaile
et al. [28] found that CWT performed daily for 4 consec-
utive days post-exercise enhanced recovery of cycling
time-trial performance on days 2–5 (0.0–1.7 %) compared
with control (-2.6 to -3.8 %), but did not improve
recovery of sprint performance (0.5–2.2 %) until days
4 and 5 compared with control (-1.7 to -4.9 %). Their
results indicated that the benefits of CWT may be greater
when athletes have cumulative fatigue from multiple daily
training sessions. Vaile et al. [48] reported that daily CWT
Water Immersion Recovery for Athletes
Author's personal copy
for 4 days enhanced recovery of squat-jump performance
(24 h: -6.7 %, 48 h: -3.4 %, 72 h: 0.0 %) compared with
control (24 h: -14.6 %, 48 h: -12.5 %, 72 h: -7.8 %)
and isometric squat performance (24 h: -10.3 %, 48 h:
-7.4 %, 72 h: -2.8 %) compared with control (24 h:
-17.3 %, 48 h: -14.0 %, 72 h: -11.5 %), at 24, 48 and
72 h after participants undertook a delayed onset-muscle-
soreness-inducing leg-press protocol.
Other studies have used similar CWT protocols to Vaile
et al. [28, 48] and found improvements in recovery of
exercise performance. An earlier study by Vaile et al. [86]
also used a delayed onset-muscle-soreness-inducing leg-
press protocol and found that CWT (alternating 1 min in
8–10 �C, and 2 min in 40–42 �C, for 15 min) enhanced
recovery of isometric squat force (mean ± SD 24 h:
*- 6 ± 21 %, 48 h: *- 11 ± 16 %) compared with
control (24 h: -20.8 ± 15.6 %, 48 h: -22.5 ± 12.3 %),
and jump-squat peak power (24 h: *- 9 ± 12 %, 48 h:
*- 3 ± 16 %) compared with control (24 h: -18.0 ±
11.6 %, 48 h: -22.7 ± 15.8 %), despite participants only
immersing in the water to the level of the anterior superior
iliac crest, using 8–10 �C instead of 15 �C CWI, and
spending twice as much time in the hot than the cold water.
Higgins et al. [65] reported that post-exercise CWT
(alternating 1 min in 10–12 �C, and 1 min in 38–40 �C, for
7 min) performed 3 times per week for 4 weeks enhanced
recovery of 300 m sprint performance (0.72 ES), but had
no significant effect on repeat sprint performance in well
trained rugby union players.
Furthermore, Buchheit et al. [89] reported that CWT
(2 min in an 85–90 �C sauna, 2 min in 36 ± 2 �C water to
midsternal level, 2 min in 12 ± 1 �C water to iliac crest
level, repeated 3 times) performed 12–15 h post-match can
enhance recovery of football match running performance
(sprinting distance 30 ± 67 %, peak match speed
6 ± 3 %) over two consecutive games within 48 h in
highly trained youth footballers. However, their results
should be interpreted with care as the study was conducted
retrospectively by analysing data from a competitive sea-
son that met criteria for inclusion in their study. Data from
only five participants were included and, due to the retro-
spective nature of the study, there appeared to be little
control over other recovery practices performed by the
footballers between consecutive games.
The duration of CWT may influence its effect on
recovery of exercise performance. Versey et al. [25, 90]
conducted two studies investigating whether post-exercise
CWT (alternating 1 min in 38 �C, and 1 min in 15 �C for
6, 12 or 18 min to the shoulders) had a dose-response effect
on recovery of exercise performance. Both studies found
that a dose-response relationship did not exist, but CWT for
6 and 12 min accelerated recovery of sprint and time-trial
cycling performances 2 h later, while CWT for 6 min
assisted recovery of 3,000 m running performance. These
findings suggest that CWT for 6–12 min duration is more
effective at accelerating recovery of exercise performance
than longer durations such as 18 min. While these findings
may also imply that CWT for 12 min is only effective for
recovery following concentric-only exercise, it should be
noted that the original authors suggested that CWT for 12
and 18 min may have failed to assist recovery of running
performance because their cooling effects were too large
for the cold environmental conditions experienced by
participants [90]. Therefore, the different findings could be
due to the environmental conditions experienced during
each study, and further research is required to determine
whether CWT affects recovery from running and cycling
performance differently. In addition, it has been suggested
that the stimulus for benefits from CWT is the movement
between extreme temperatures [40], therefore it would
seem logical for CWT protocols to consist of short
immersions (*1 min) and alternate frequently between the
hot and cold water.
Eleven studies have found little or no enhancement in
recovery of exercise performance after undertaking post-
exercise CWT [44–46, 57, 67, 71, 84, 85, 87, 88, 91];
however, some have had methodological issues, possibly
compromising their ability to observe an improvement in
performance [46, 57, 68, 84, 88]. Coffey et al. [84], King
and Duffield [68] and Robey et al. [46] used methodology
that failed to detect a decrease in performance in their
control trials. Therefore, either the exercise protocols did
not induce sufficient fatigue, or the performance tests used
were inappropriate to detect the fatigue. An improvement
in exercise performance compared with baseline would
have been required for CWT to assist recovery. This is
unlikely to occur and would bring into question the validity
of the baseline performance. Hamlin [88] and Kinugasa
and Kilding [57] compared CWT with active recovery
(6 min jogging at 6.8 km/h) and stretching (7 min of static
stretching and 2 min with legs above the heart), respec-
tively, rather than a resting control condition. If active
recovery or stretching assisted recovery of exercise per-
formance it would decrease the possibility of finding a
significantly beneficial effect from CWT.
The remaining studies that found CWT had no signifi-
cant effect on performance recovery [44, 45, 67, 71, 85, 87]
all used CWT protocols that differed from the relatively
similar protocols used in studies that reported recovery
benefits, therefore it appears that certain CWT protocols
are less likely to assist recovery than others. Vaile et al.
[28, 48] compared different water immersion recovery
interventions and reported that CWI assisted recovery of
exercise performance, while HWI did not have the same
benefits. Consequently, CWT protocols containing 2–3
times more HWI than CWI seem counterintuitive and have
N. G. Versey et al.
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generally failed to assist recovery of exercise performance
[45, 46, 57, 68, 84, 85, 87, 91]. In addition, it appears
reasonable that increasing the amount of the body
immersed during CWT would increase the possibility of a
physiological response to either the water immersion or the
extreme temperatures [35]. Several studies have only
immersed the lower part of the body during CWT [44, 46,
66–68, 84, 86–88], thereby potentially decreasing the
magnitude of any physiological response. Most of these
studies have been unsuccessful at accelerating recovery of
exercise performance [44, 46, 67, 84, 87, 88]. Some studies
have used a hot shower instead of pool immersion,
decreasing the body surface area in contact with hot water
and removing any potential benefits from hydrostatic
pressure on the body while in the shower [46, 57, 67, 68,
87, 88]. Likewise, these studies have typically failed to
assist recovery of subsequent exercise performance.
Finishing CWT in either hot or cold water does not
appear to influence the likelihood of subsequent perfor-
mance benefits. Of the nine studies to find a benefit, four
finished in hot [65, 68, 86] and five in cold water [25, 28,
48, 89, 90]. Studies that did not report an improvement in
exercise performance were split six to four for finishing in
hot [44, 57, 67, 84, 87, 88] and cold water [45, 46, 71, 85,
91], respectively.
2.4 Thermoneutral Water Immersion ([20 to \36 �C)
2.4.1 Overview
Water temperatures of approximately 35 �C are considered
to be thermoneutral as they do not alter core temperature
during prolonged immersion [11]. Consequently, some
studies have used immersion in approximately 35 �C as a
control condition to isolate the effects of water temperature
from those of water immersion on post-exercise recovery.
These studies are discussed in the section on CWI as they do
not contain a control condition without immersion [49, 54,
69, 70]. For the purposes of this review, water immersion
performed in swimming pools has been included in TWI
[47, 87, 92–95]. Consequently, TWI temperatures in the
literature range from 24 to\36 �C [47, 49, 54, 69, 70, 87,
95]; however, some studies have failed to report water
temperature [92–94]. Typical immersion durations range
from 15 to 30 min [47, 87, 92, 94, 95]. Unlike the other
water immersion techniques, published TWI protocols often
contain swimming, walking and other aerobic exercises [47,
87, 92–95], while, anecdotally, athletes may also perform
stretching during immersion. The water temperature
required for TWI is relatively easy to obtain as swimming
pools are usually more readily available than cold or hot
pools, and tap water may be used to achieve the desired
temperature in a bath without cooling or heating the water.
2.4.2 Performance Effects
To our knowledge, six studies have examined the effect of
TWI on recovery of exercise performance compared with a
control condition [47, 87, 92–95]. In five studies [47, 87,
92, 94, 95], participants performed TWI containing low-
intensity exercise that appeared to be designed to enhance
recovery, adding active recovery as a new mechanism in
addition to water immersion by which performance
recovery might be affected. Despite the inclusion of low-
intensity aerobic exercise in the five studies [47, 87, 92, 94,
95], contrasting findings were reported. Dawson et al. [87]
found that TWI (15 min walking in 28 �C shallow water)
improved recovery of vertical jump, but not cycling sprint
performance 15 h after Australian football games (1.02
ES). Meanwhile, Takahashi et al. [47] reported that TWI
(30 min of aqua exercise in 29 �C water) helped maintain
leg muscle peak power 24 h after downhill running
(-4.1 %) compared with control (-16.5 %). In contrast,
Cortis et al. [92] and Tessitore et al. [94, 95] found that
20 min of shallow water aerobic exercise had no significant
effect on recovery of explosive exercise performance after
6.5 h and about 5 h, respectively. In Tessitore et al. [95]
TWI was performed in 30 �C water; however while neither
of the other two studies reported water temperature [92,
94], it is likely that they were performed in swimming
pools of 25–30 �C. While the fatiguing exercise bouts
differed between these four studies, both the performance
measures and TWI protocols were similar [47, 87, 92, 94,
95]. It is possible that the different fatiguing exercise bouts
or timing of the post-exercise performance measures
(5–24 h) could explain the contrasting findings [8, 72].
Cortis et al. [92] and Tessitore et al. [94, 95] may have
found different outcomes if the performance measures had
been performed the day after TWI.
Another study [93] examined the effect of a 45–60 min
high-intensity swimming interval training session 10 h
after a high-intensity interval running session on recovery
of running performance in triathletes. Despite the high-
intensity of the swimming session, Lum et al. [93] reported
that running time to fatigue was greater (830 ± 198 s)
compared with control (728 ± 183 s) at 24 h post-exer-
cise. Based on the available literature, there is a possibility
that TWI combined with aerobic exercise may improve
recovery of explosive exercise performance; however, due
to the contrasting findings and lack of available literature,
this is uncertain.
2.5 Comparison of Water Immersion Recovery
Techniques Performance Effects
To optimize the recovery of exercise performance, athletes
need to know which water immersion technique will
Water Immersion Recovery for Athletes
Author's personal copy
provide them with the greatest recovery benefits. Further-
more, it is possible that the optimal immersion technique
may differ between sports, because certain recovery tech-
niques may assist recovery from some forms of exercise
more than others [8, 72]. Vaile et al. conducted two
important studies [28, 48] that aimed to answer these
questions by comparing the effect of full-body CWI
(15 �C), HWI (38 �C), CWT (alternating 1 min in 38 �C,
and 1 min in 15 �C) and control for 14 min on recovery of
sprint and time-trial cycling performance [28], and the
functional deficits associated with delayed onset muscle
soreness [48]. Both studies used the same water immersion
protocols and suggested that daily CWI and CWT assisted
recovery of performance by similar amounts, and more so
than HWI or control during the 3–4 days post-exercise.
Moreover, both CWI and CWT assisted recovery by a
greater percentage compared with control following mus-
cle damaging exercise (2–10 %) [48], compared with
cycling performance (0–2 %) [28]. While it should be
remembered that the performance tests differed between
the two studies, these findings not only suggest that CWI
and CWT are likely to provide athletes with the greatest
recovery benefits, but also that the recovery benefits may
be greater following muscle-damaging exercise than
cycling.
The findings of Vaile et al. [28, 48] contradict those of
an earlier study by Kuligowski et al. [45] that also com-
pared CWI (13 �C), HWI (39 �C), CWT (alternating 3-min
HWI, and 1-min CWI) and control for 24 min performed
daily for 3 days following eccentric elbow flexor contrac-
tions. It was found that none of the water immersion
techniques affected recovery of elbow flexor maximal
voluntary isometric contraction during the next 4 days. The
lack of significant findings could have been because the
participants were untrained and they did not perform
whole-body sports-specific exercise, as only one arm was
exercised and immersed [9, 78].
Other studies have compared CWI and CWT in team
sport athletes, but their findings have been inconsistent and
inconclusive [44, 45, 57, 65, 67, 87]. Higgins et al. [65]
suggested that CWT (alternating 1 min in 10–12 �C, and
1 min in 38–40 �C, for 7 min) assisted recovery of anaer-
obic exercise performance in rugby players by a greater
amount (repeat sprint test: 0.99 ES, 300 m sprint: 0.53 ES)
than CWI (5 min in 10–12 �C to above waistline) when
performed 3 times per week for 4 weeks. In contrast, In-
gram et al. [44] found that CWI (5 min in 10 �C, 2.5 min
out of the water, 5 min in 10 �C to umbilicus) helped
maintain repeat sprint ability by a greater amount (1.56 ES)
than CWT (alternating 2 min in 10 �C, and 2 min 40 �C,
for 12 min to umbilicus) in team sport athletes when per-
formed immediately and 24 h after simulated team sport
exercise; however, fastest sprint time and maximal
isometric leg strength was not significantly affected. Fur-
thermore, Hamlin [67] reported that neither post-exercise
CWI (alternating 1 min in 8–10 �C, and 1 min air, for
6 min) nor CWT (alternating 1 min in 8–10 �C, and 1 min
in a 38 �C shower for 6 min) accelerated recovery of repeat
sprint-test performance in developmental netballers 2 h
after high-intensity running. This could have been because
participants only spent 3 min with just their legs immersed
in water during each intervention; the stimulus may have
been insufficient to accelerate recovery. While Kinugasa
and Kilding [57] also investigated both CWI and CWT, a
comparison between their effects on performance recovery
is not appropriate as the CWI was confounded by the
inclusion of active recovery that was not included in the
CWT. The reasons for these inconsistent findings are
unclear at this stage; however, it may be related to the
differences in exercise and water immersion protocols
between studies [8, 72].
Based on the available literature, it appears likely that
CWI and CWT assist recovery of exercise performance
more than HWI and TWI, but it is unclear which technique
is most effective. It is possible that the optimal water
immersion technique and protocol for recovery of perfor-
mance may depend on the type of exercise performed [8,
72], but insufficient evidence is available to determine
whether this notion is correct.
3 Effect of Water Immersion on Training Adaptations
The water immersion recovery literature primarily exam-
ines the short-term effects on recovery of exercise perfor-
mance and physiological markers of recovery. While this
literature suggests that some water immersion techniques
may assist in acute recovery of performance in the days
following fatiguing exercise, concern exists as to whether
these techniques, in particular CWI, affect long-term
adaptation to training [43, 51, 65]. One theory suggests that
water immersion techniques could assist acute recovery,
therefore allowing athletes to perform a larger training load
(increased frequency, intensity or duration) in subsequent
sessions, in turn producing a greater stimulus for adaptation
[8, 9, 96]. Alternatively, by disrupting the mechanisms of
fatigue, recovery techniques may blunt chronic adaptations
to training [43, 51]. This ‘adaptation’ issue is important to
all athletes; although, it is likely to be of greatest impor-
tance to sports in which physical condition is the primary
influence on the outcome, and sports that only have a few
important competitions per season. In highly skilled or
team sports, the benefits of the potential for an increase in
training load, and therefore time practising skills or
developing understanding with team-mates may offset any
potential detrimental effects on physical conditioning.
N. G. Versey et al.
Author's personal copy
Three studies have attempted to address this issue by
examining the effect of regular CWI over 3–6 weeks of
training [43, 51, 65]. Three of the four experiments conducted
by Yamane et al. [51] found that regular CWI attenuated
training-induced improvements in cycling ability or handgrip
strength compared with control (Table 1). However, their
results should be interpreted with caution because participant
numbers were low, they were sedentary adults rather than
trained athletes and only one limb was immersed in water (the
other was the control) rather than half- to full-body immer-
sion. In addition, Higgins et al. [65] reported that regular CWI
decreased repeat sprint test performance (-0.62 ES), but had
no significant effect on 300 m sprint test performance (0.17
ES) when compared with a control condition in rugby union
players. However, there appeared to be potential for sub-
stantial human error in their test results due to visual obser-
vation of the distance covered during the repeat sprint test and
hand timing of the 300 m sprint test. Howatson et al. [43]
reported that CWI (12 min in 15 ± 1 �C to iliac crest) per-
formed daily for 3 days following muscle-damaging exercise
neither inhibited nor promoted the repeated bout effect during
the subsequent 4 days. The current literature suggests that
CWI may attenuate adaptations to training; however, due to
the methodology employed in existing studies, further
research investigating the effects on adaptation for athletic
performance is required.
4 Future Research
Insufficient literature is available to conclusively answer
numerous questions regarding the use of water immersion
for post-exercise recovery. Future research should compare
CWI and CWT to determine the optimal water immersion
technique and examine the effects of regular post-exercise
water immersion on long-term adaptations to training. In
addition, research is needed to confirm the optimal water
temperatures, immersion durations, immersion depths,
timing post-exercise and time before subsequent exercise
for CWI, HWI, CWT and TWI. The timing post-exercise
would be of particular interest to athletes that do not have
access to pools at their training facility, or do not have time
to undertake water immersion until the end of the day or
the following morning. To our knowledge, no studies have
directly compared full-body immersion to half-body
immersion using CWI, HWI, CWT or TWI to determine
whether immersion depth influences recovery of perfor-
mance. In addition, further research is required to deter-
mine whether using showers instead of water immersion
influences the effect on subsequent exercise performance.
It should be noted that for many of these questions the
outcomes may differ depending on the mode of exercise
and the environmental conditions involved.
Questions relating to specific water immersion tech-
niques also remain unanswered. Further research is nec-
essary to determine whether post-exercise HWI influences
recovery of performance and it is unknown whether CWT
should conclude in hot or cold water. Insufficient literature
is available to conclusively determine whether TWI com-
bined with aerobic exercise accelerates recovery of exer-
cise performance. In addition, to date no studies have
examined the effect of performing TWI without concurrent
exercise on recovery of performance compared with a
control condition; therefore it is unknown whether exercise
plays a critical role in the ability of TWI to enhance
recovery of performance.
5 Practical Recommendations
This section provides practical recommendations on the
use of water immersion for recovery of athletic perfor-
mance. The recommendations are primarily based on the
literature discussed in this review. However, some topics
have not been adequately investigated in the literature;
therefore recommendations on these topics are based on
current theoretical best practices. The authors acknowledge
that further research is required to confirm these
recommendations.
5.1 Water Immersion Techniques
CWI and CWT should assist recovery of exercise perfor-
mance more than HWI and TWI when performed appro-
priately. Greater scientific and anecdotal support exists for
the use of CWI compared with CWT; however, further
direct comparisons are needed between the two techniques
to conclusively determine which is more effective. Insuf-
ficient literature is available to determine whether the use
of either CWI or CWT is more effective at accelerating
recovery from different forms of fatigue (e.g. neural fatigue
vs. muscle damage). Therefore, it is not possible to rec-
ommend a particular water immersion technique for
recovery from specific modes of exercise. Athletes with an
elevated core temperature (often caused by sustained high-
intensity exercise in hot conditions) should perform CWI
as first preference, as it is likely to cause the greatest rate of
decrease in core temperature, but CWT may be preferable
for athletes with a lower core temperature to limit further
decline. Athletes with an injury should follow medical
advice when considering the use of HWI, CWI or CWT.
5.2 Water Temperatures and Immersion Durations
The optimal temperature for CWI appears to be in the
range of 10–15 �C. When performing CWT, the same
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Author's personal copy
temperature CWI should be used in conjunction to HWI in
about 38 �C. The ideal CWI duration is likely to be in the
range of 5–15 min; however, this probably depends on the
water temperature (the lower the water temperature, the
shorter the immersion duration). The ideal CWT duration is
uncertain; although the available data suggests it is up to
15 min in total.
5.3 Water Immersion Depth and Whether to be
Activity or Passive
To our knowledge, no studies have compared the influence
of immersion depth on the effectiveness of water immer-
sion for recovery of exercise performance. Nonetheless, it
appears logical that the greater the immersion depth, the
greater the physiological effect on the body and therefore
the potential performance benefits. In addition, it is
unknown whether participants should be active or passive
during immersion.
5.4 Timing of Water Immersion Post-Exercise
It is recommended that athletes perform water immersion
techniques as soon as practical post-exercise to obtain the
greatest recovery benefits. Any recovery effects may be
reduced when water immersion is performed some hours
after exercise or the following day. Most studies that report
recovery benefits have commenced water immersion
within 30-min post-exercise.
5.5 Time to Subsequent Exercise
When selecting a water immersion recovery technique, the
time to the subsequent exercise bout should be considered
due to the cooling effects of CWI and CWT. Following
CWI and CWT, athletes should allow sufficient time for
internal body temperatures to increase so subsequent
exercise performance is not compromised. If exercise is
performed soon after (B45 min) water immersion, CWI
and CWT may decrease exercise performance, particularly
if the exercise is high-intensity or explosive in nature.
However, when exercising in a warm-to-hot environment,
pre-cooling might enhance subsequent exercise perfor-
mance and therefore be desired, principally for prolonged
exercise. In this case, athletes should perform an appro-
priate sports-specific warm-up so subsequent exercise
performance is not compromised.
5.6 Effect of Water Immersion on Training
Adaptations
The effect of water immersion on adaptation to training is
not known. If immersion does not alter adaptation
processes, it can be used to accelerate recovery in the daily
training environment. However, if water immersion atten-
uates adaptations to training, then it should primarily be
used between competitions when limited recovery time
exists. Furthermore, if immersion impairs adaptation pro-
cesses, its use may still be beneficial for highly skilled or
team sports athletes through the potential for an increase in
skill development and teamwork.
6 Conclusions
Most of the literature investigating post-exercise water
immersion for recovery of exercise performance has
focused on CWI and CWT, with few studies examining
HWI and TWI. Based on the current literature, both CWI
and CWT can assist recovery of exercise performance
when conducted appropriately; however, it is unclear
which technique is more effective. Due to the lack of lit-
erature and contrasting findings, it is uncertain whether
HWI and TWI assist performance recovery. Future
research should aim to determine whether water immersion
techniques are more effective at assisting recovery from
some forms of fatigue than others, and should answer key
practical questions that have yet to be resolved.
Acknowledgements The authors declare that they have no conflicts
of interest relevant to this review and no funding was used to assist in
the preparation of this review.
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